An adult in the emergency department has symptomatic bradycardia with a pulse and hypotension despite adequate oxygenation. As the first pharmacological step in the bradycardia algorithm, the correct atropine regimen is:

• A Atropine 1 mg IV every 3 to 5 minutes, maximum total dose 3 mg ✓
• B Atropine 0.5 mg IV every 3 to 5 minutes, maximum total dose 3 mg
• C Atropine 3 mg IV as a single bolus, repeated once after 5 minutes
• D Atropine 1 mg IV every 10 minutes, maximum total dose 5 mg

Explanation

The ACLS bradycardia algorithm gives atropine 1 mg IV as the first dose, repeated every 3 to 5 minutes to a maximum cumulative dose of 3 mg. The 0.5 mg option reflects older or paediatric-style dosing and risks paradoxical bradycardia at low doses. If atropine fails, transcutaneous pacing or dopamine or epinephrine infusion follows. Total doses above 3 mg confer no benefit and increase toxicity risk.

Reference: AHA ACLS Provider Manual, 2020 guidelines ed.

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Written and medically reviewed by the StethoPrep medical team.