asked 3 years ago
In the updated ALS 4.9; the Symptomatic Bradycardia Directive states: "TCP should not be delayed for placement of an IV." Because Atropine is given via IV; would it be appropriate to initiate TCP first; then establish IV access and proceed with Atropine if TCP is ineffective?
1 Answers
answered 3 years ago
Thank you for the question regarding Symptomatic Bradycardia and the clinical consideration “TCP should not be delayed for placement of an IV”.
The reality is that symptomatic bradycardia can be treated in various ways. Obviously Fluids, Atropine and Dopamine will require IV access. Should you decide that TCP is the preferred choice in treating your patient, IV access does not need to be obtained prior to initiating pacing. This was placed to ensure patients are treated in a timely fashion should urgent TCP be required. It eliminates the paramedic trying to start an IV several times while the patient remains hypotensive.
I would further elaborate that Fluids, Atropine and Dopamine remain great alternatives to TCP but will take time to initiate. TCP would be the best treatment for patients who are severely symptomatic, pre-arrest type of scenario. In these cases, TCP initiation should not be delayed.
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