If atropine is NOT effective, which intervention is used to maintain heart rate and blood pressure?

• A. Push-dose Epinephrine 10 mcg IV/IO, may repeat q2-5 mins
• B. Atropine 1 mg
• C. Synchronized Cardioversion
• D. Defibrillation

Answer: (A)

In symptomatic bradycardia, you first give atropine to increase the heart rate, but if it doesn’t work you need rapid, temporary support to preserve perfusion while preparing longer-term measures. Push-dose epinephrine provides immediate chronotropic and vasopressor effects, quickly raising both heart rate and blood pressure. The small IV/IO bolus of 10 mcg can be repeated every 2–5 minutes as needed, acting as a bridge to transcutaneous pacing or a continuous epinephrine infusion. Epinephrine works by stimulating beta-1 receptors to boost heart rate and contractility, and alpha-1 receptors to raise vascular tone. Other options don’t fit: repeating atropine doesn’t address the failure, synchronized cardioversion targets tachyarrhythmias, and defibrillation is for pulseless arrests like VT/VF, not bradycardia.