Atropine in the Field
Objective: Use atropine for selected bradycardia. It is less reliable below the AV node. Do not delay pacing. Keep organophosphate atropine on a separate protocol. Your protocol card sets the amount.
Why this matters
Atropine is for selected bradycardia. Picture a heart rate of 38 and low blood pressure. It is easy to give atropine, wait, give it again, and never turn the pacer on.
Atropine can help some bradycardias that start at the AV node. It is less effective when the block is below the AV node, as in Mobitz II and complete heart block. Do not wait on another dose before you pace. Your protocol card sets the amount. This page does not list a dose.
- This page does not list a dose. Your protocol sets the dose and whether you repeat it.
- If the patient is unstable in complete heart block, put the pads on now.
- Organophosphate poisoning is a hazardous-materials pathway. Do not use the bradycardia atropine dose for it. Do not multiply that dose in your head.
Clinical sequence
- Unstable bradycardia: give atropine per protocol while you set up pacing. If the patient is unstable, do not wait through several atropine doses before the pads are on.
- If the patient is unstable in complete heart block, put the pads on now. Atropine is less reliable in Mobitz II and complete heart block. Do not add delay.
- Keep organophosphate atropine on a different protocol. A cholinergic poisoning, with salivation, tearing, urination, diarrhea, and vomiting, is a hazardous-materials pathway. Do not scale the bradycardia dose.
Teaching points
- Bradycardia: atropine may reverse vagal or AV-nodal slowing. An unstable patient still needs transcutaneous pacing ready.
- Mobitz II and complete heart block: atropine is less reliable. Do not delay pacing.
- A heart-transplant patient may not respond, because the heart has no vagus nerve to block. Use your protocol or online medical control.
- Cholinergic poisoning uses atropine differently. See the toxidrome lesson. Do not mix the two protocols.
Common errors
- Waiting through several atropine doses in unstable complete heart block.
- Using the bradycardia dose for an organophosphate exposure, or scaling that dose from memory.
- Drawing the drug while the pads are still in the bag.
Practice
One-minute check
With a partner: heart rate 30, complete heart block, blood pressure 60. Say whether atropine or pacing comes first, and why. Say when the pads go on.
Related: Transcutaneous pacing, Bradycardia.
Sources & Further Study
Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.
- NASEMSO National Model EMS Clinical Guidelines (2022) — U.S. EMS model language. Your protocol still decides.
- AHA 2025 Part 9: Adult ALS — Atropine may be used for bradycardia. It is less effective below the AV node. Do not delay pacing.
Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.
Check Your Understanding
Questions drawn only from this lesson. After you check, the key is highlighted. Education practice — not a certification exam.