A patient presenting with bradycardia after ingested digoxin should have what initial treatment?

In cases of bradycardia resulting from digoxin toxicity, the initial treatment is to administer digoxin-specific antibody fragments, also known as Digibind or Digifab. These antibodies bind to digoxin in the circulation, neutralizing its effects and facilitating its excretion from the body. This approach is critical, as it addresses the root cause of the bradycardia by effectively removing the active drug from the system, thereby improving the heart rate and alleviating symptoms associated with toxicity.

Other interventions, such as administering atropine or starting a permanent pacemaker, might be considered in certain scenarios of bradycardia; however, they do not directly counteract the effects of digoxin in cases of intoxication. Atropine may temporarily increase heart rate, but it does not address the ongoing effects of digoxin. A permanent pacemaker is typically reserved for chronic cases of bradycardia or those not responding to other treatments, which would not be appropriate as an initial response to acute digoxin toxicity. Additionally, intravenous fluids are not a specific treatment for bradycardia due to digoxin toxicity and do not influence the underlying issue.