You have an adult patient who is post cardiac arrest. They are bradycardic (rate 30-40) and profoundly hypotensive (blood pressure unobtainable). You have the patient intubated with an IV in place and flowing well. Of course the first response in this situation is to initiate a fluid bolus. What I'm specifically wanting to get clarified is the role of dopamine.
In the ROSC medical directive the patient simply needs to meet the condition of "hypotension" for a dopamine infusion to be started with no patch required. In the Symptomatic Bradycardia medical directive dopamine requires the heart rate to also be <50bpm and a patch to initiate the infusion. In the situation of a post-arrest patient who is also bradycardic, is a patch required in order to initiate a dopamine infusion or would the expectation be that a paramedic would initiate the infusion? Should we initiate dopamine and then patch for pacing as well? Secondarily, what role/timing would Atropine play in all of this?
No, a patch is not required to administer dopamine as the post ROSC supersedes symptomatic bradycardia medical directive. Atropine would unlikely help in this scenario and you should go directly to pacing.