If atropine is effective, what is the subsequent dosing schedule?

• A. Atropine 1 mg IV/IO every 3-5 min, max total 3 mg
• B. Atropine 2 mg IV/IO every 10 min
• C. Epinephrine 10 mcg IV/IO every 2-5 min
• D. Dopamine infusion

Answer: (A)

When treating symptomatic bradycardia, atropine works by blocking the parasympathetic influence on the heart, which speeds the heart rate and improves AV conduction. If atropine produces a positive response, you continue giving small, cautious doses at short intervals to maintain improvement while avoiding overshoot into tachycardia. The recommended approach is to administer 1 mg IV/IO and repeat every 3-5 minutes as needed, with a maximum total dose of 3 mg. This titration keeps the patient responsive and avoids excessive anticholinergic effects. If there’s no durable response after reaching the maximum dose, escalate to pacing or vasopressor support per protocol.