Question

A 63 y/o female complains of chest pain. The monitor reveals a sinus bradycardia at 42. Vitals are P 42, R 15, BP 86/60, SaO2 of 94%. You have established IV access and administered the maximum dose of atropine. Pacing has failed to capture. What two medications may be ordered by the medical command physician?

[1]Medication 1 and initial dose

Answer 1

In a case of sinus bradycardia unresponsive to atropine and pacing, the medical command physician might order dopamine and epinephrine as vasopressors and inotropic agents to increase heart rate and blood pressure, starting with low doses and titrating as necessary.

Explanation;

A 63-year-old female with sinus bradycardia, chest pain, and hypotension unresponsive to atropine and pacing may require further pharmacological intervention. The medical command physician may consider dopamine and epinephrine as the next medications. Physicians generally start with an initial dose of 2-20 micrograms per kilogram of body weight per minute for dopamine, and for epinephrine, they may begin with 2-10 micrograms per minute. It’s beneficial to start at lower dosages and adjust as necessary based on the patient's response and vitals.

Dopamine and epinephrine act as vasopressors and inotropic agents, which can increase heart rate and blood pressure. This is particularly important in patients who exhibit symptoms indicating that the heart is unable to maintain adequate blood flow, leading to insufficient oxygen delivery to the body's tissues. The choice between these medications and their dosing will be highly individualized and based on the patient’s specific clinical presentation, monitored closely for effectiveness and any adverse effects.