Atropine dose for adult bradycardia in ALS: which statement is correct?

• A. Atropine, 1 mg IV/IO. May repeat every five minutes up to a maximum of 3 mg or 0.04 mg/kg.
• B. Atropine, 2 mg IV/IO, repeat at 2 mg increments every five minutes if patient remains symptomatic.
• C. Atropine, 0.5 mg IV/IO can be given once.
• D. Atropine, 3 mg IV/IO with no repeats.

Answer: (A)

In adult ALS management of symptomatic bradycardia, the recommended atropine approach is 1 mg IV/IO, with repeats of 1 mg every 3–5 minutes as needed, up to a maximum total dose of 3 mg (or 0.04 mg/kg). This dosing starts with a single, standard bolus to quickly counteract excessive vagal tone and may be repeated if the rhythm remains bradycardic, without exceeding the weight-based cap. The other dosing schemes don’t align with this standard: giving a higher initial dose or larger subsequent increments isn’t how atropine is typically titrated in this scenario, a single small dose may be insufficient for many adults, and stating no repeats ignores the possibility that bradycardia persists and requires additional dosing or escalation. If atropine fails to improve the rate within the allowed dosing, proceed to pacing or other therapies as indicated.