Tiffany - 40 - identical twin (shellshokt) Mother - ER/critical care RN - nightshift - Roller Derby Medic - Living with Lupus (SLE) & Rheumatoid Arthritis (RA)
54 to M Came to the ER for an ear ache lasting 5 days even after being on Amoxicillin…
Pt has an ear infection.
Pain has Meds on board, no relief after 1 hour.
Soooo, Doc orders a CT to R/O a perforation…
Pt refuses…. ?
If you don’t want a bunch of tests done, don’t come to the ER at 4 in the morning.
Go home man.
54 yo M with earache x 5 days
92 yo F with constipation
18mos old F with inability to sleep
A transplanted heart does not respond to atropine
This is because atropine affects the vagus nerve (parasympathetic innervation of the heart), not the heart itself.
Since a transplanted heart is not connected to the recipient’s nerves, atropine will have limited or no effect on the donor heart. Neither will vagal stimulation like Valsalva maneuvre or carotid massage
Eventually however, there may be some regeneration of nervous innervation to the new heart; mostly sympathetic, but also parasympathetic nerves. In that case, atropine might work.
But the treatment of choice in hemodynamically significant bradycardia in heart recipients, is pacing (according to ACLS guidelines).