[Doczilla]

Things are going terribly wrong here...

Atropine is not a beta blocker, as SS pointed out. Atropine can be a bronchodilator since it is a vagolytic drug, and a similar drug, Atrovent (Ipratropium Bromide) is inhaled to help with bronchodilation. In a pinch, you could nebulize atropine for bronchodilation, but I don't recommend doing this if you have Atrovent available. Atropine's role in anaphylaxis is quite limited, so I'd put it out of your mind. I can really only see giving atropine if the secretions are so severe as to compromise the airway or if the patient has profound bradycardia.

If the patient was hypertensive (rare, and should make you question the diagnosis of anaphylaxis), I would gear therapy toward relieving the bronchoconstriction with beta agonists such as inhaled albuterol in conjunction with inhaled ipratropium. Systemic steroids and antihistamines would also be indicated. If air movement was compromised enough, I'd give the epi anyway in spite of the elevated blood pressure. Anxiety from hypoxia can potentially elevate BP and heart rate, so you need to get to the underlying problem of airway compromise.

Patients with a HISTORY of hypertension may be TAKING beta blockers (drugs that end in -olol, such as metoprolol, atenolol, propranolol, and a couple of exceptions to this rule, carvedilol and labetalol), which may make them resistant to the epinephrine you are giving to reverse the bronchoconstriction and vasodilation which normally accompanies anaphylaxis. For these patients, glucagon may be helpful, as this will activate many of the same pathways as epi but without needing to interact with the beta receptors.

'zilla