A symptomatic patient with bradycardia (HR 42 bpm) on telemetry is likely to require which initial management step?

• A. Administer atropine 0.5 mg IV every 3-5 minutes up to 3 mg; prepare for pacing if unresponsive
• B. Initiate transcutaneous pacing
• C. Begin dopamine infusion
• D. Synchronized cardioversion

Answer: (A)

When a patient is symptomatic with bradycardia, the rapid goal is to increase heart rate and improve perfusion. The first-line step is giving atropine because it blocks vagal effects on the heart, boosting SA node automaticity and AV conduction quickly. Administer 0.5 mg IV push, repeating every 3–5 minutes up to a total of 3 mg if needed. If the bradycardia persists or the patient remains unstable after atropine, prepare for pacing (transcutaneous pacing) and consider dopamine or epinephrine infusions as temporizing measures. Synchronized cardioversion is not the initial choice for bradycardia; it’s reserved for unstable tachyarrhythmias. Ensure airway, oxygenation, IV access, and continuous monitoring while addressing the underlying cause.