Inhalation: by nebulized inhalation (Wiener and Hoffman 2004) or via the intratracheal route.Intramuscular: Research for this Case Study did not turn up any comparisons of intramuscular with inhalation routes of atropine administration.Army Soldier and Biological Chemical Command (SBCCOM). The effects of atropine versus route and method of administration. Thus, the patient’s left side is shown on the right.)įigure 12. (Note: the correct way to view an X-ray is as if the patient was facing you. The autoinjector medication is obviously more efficiently diffused into surrounding muscle due to the force with which it is expelled from the injector (as seen in inset photo.) Source: U.S. The X-ray shows autoinjector doses (on left) compared to standard syringe IM doses (on right). The rapid absorption of antidote following automatic injection is enhanced by the degree of tissue dispersion achieved by the auto-injector. X-ray showing autoinjector effectiveness. Army Soldier and Biological Chemical Command (SBCCOM).įigure 11. Military MARK I Kit containing atropine and 2-PAM autoinjectors. (Sidell 1997 Wiener and Hoffman 2004) Pediatric atropine autoinjector syringes are now available in 0.5 mg and 1 mg sizes. Note that each MARK I kit contains an atropine autoinjector, containing 2 mg of atropine plus another autoinjector containing 600 mg of 2-PAM. Military MARK I atropine autoinjector: Although intravenous injection is the preferred route of administration, use of the autoinjector may be more practical in the field, where it can be rapidly administered even through clothing.) Blood levels are achieved more rapidly than by other forms of IM injection.Intraosseous: (American Heart Association 2005) bolus, followed by continuous infusion.In approximate order of preference, the following routes of administration can be used for the administration of atropine Preparing for chemical terrorism: Stability of injectable atropine sulfate. Note: Tropine, a marker of degradation was not found in substantial amounts in any of the samples.ĭata from: Schier JG, Ravikumar PR, Nelson LS, Heller MB, Howland MA, Hoffman RS. Presumably, the solution was stored in unopened containers (as opposed to multi-dose vials from which any doses had been previously extracted, although this was not explicitly stated. The table below shows several samples of solution, dating back to World War II, showing its potency. There is evidence that atropine solution is very stable and can retain potency long after its expiration date. Thus, signs of atropinization do not always exclude the presence of cholinesterase inhibitor toxicity. Some cases of mild to moderate poisonings may improve with these doses of atropine.Parenteral atropine is not generally recommended for those whose sole manifestation of toxicity is miosis (pupillary constriction).One author points out that this strategy has never been empirically tested and may not be very sensitive or specific. ![]() 1995 Clark 2002 Erdman 2004) may be a presenting signs. 1978 Aaron and Howland 1994 Erdman 2004)and tachycardia - rather than bradycardia (3-77% of cases), (Tsachalinas, Logaras et al. In 2-13% of cases of cholinesterase inhibitor toxicity, mydriasis (pupillary dilation) - rather than miosis (pupillary constriction), (Tsachalinas, Logaras et al.2001) (Although, it does respond to topical administration). If miosis (pupillary constriction) is due to direct conjunctival vapor exposure, it is relatively unresponsive to parenteral atropine. (Durham and Hayes 1962 Tareg et al.It has been suggested that when these physiological changes do not occur with this dose (sometimes referred to as an atropine challenge), this is indicative of cholinesterase inhibitor toxicity. Most of these effects will dissipate within 4-6 hours, except blurred near-vision which may persist for 24 hours. or autoinjector administration, respectively, within about 35-45 minutes (the longer being with I.M. dose, and a maximal increase in heart rate of about 35-45 beats/minute with I.M. An increase in heart rate of about 35 beats/minute (which is usually not noticed by the recipient) within 3-5 minutes of an I.V.When given to a normal person who has not been exposed to cholinesterase inhibitors, a 2 mg dose of atropine (0.025-0.050/kg in pediatric cases) causes: A number of authors have recommended the “atropine challenge” as an aid to diagnosis.
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