I rank Atropine 12 out of the 33 drugs we carry.

Aside from routine use in cardiac arrest, I use Atropine two or three times a year for patients with symptomatic bradycardia. I have no reason to believe it does any good at all in cardiac arrest, but as far as symptomatic bradycardia, as long as the patient is not in a third-degree block, I have had good success with Atropine.

Earlier in my career, I used Atropine a bit more, but that was before I knew that many people thanks to beta blockers had every day pulses in the high 40’s, low 50’s. I also used to more readily give it to a patient having an MI (heart attack), which can increase their oxygen demand and cause more damage. Now I only give it to patients having an MI if they are hypoperfusing. Ah, the learning curve.

The best bradycardia calls are for the patient passed out in the bathroom. You find them on the floor, cold and clammy, no pressure, pulse in the 20’s. Straining to go to the bathroom, their vagus nerve overpowered them, knocking their heart rate down and they lacked the ability to rebound on their own. We used to give a full amp of Atropine, now we give 0.5, and if that doesn’t work another 0.5 mg, etc. A couple times I have given the full 1 mg by mistake. Old dogs. Still the drug works well, the pulse picks up, the patient wakes up, the skin colors up and drys out and all is well in paramedic land. “You fixed them,” the doctor says to me in the ED. Music to my ears.

If I don’t have atropine in my kit, I can always pace the patient. Other options are Dopamine and an epi drip.


We can also give Atropine to organophosphate poisionings, but I have never had one.


Atropine (Atropine Sulfate)

Class: Antimuscarinic
Parasympathetic blocker

Action: Blocks acetylcholine (ACh) at muscarinic sites

Indication: Symptomatic bradyarrhythmias
Cholinergic poisonings
Refractory bronchospasm

Contraindication: Relative contraindication wide complex bradycardia in the setting of acute ischemic chest pain

Side effects: Tachyarrhythmias
Exacerbation of Glaucoma
Precipitation of myocardial ischemia

Dose: Bradyarrhythmias – 0.5mg , may repeat every 3-5 minutes

Asystole – 1mg IV MR (May repeat) IV q 3-5 minutes (total max. dose 3mg)

Organophosphate poisonings – 1mg – 2mg; may repeat as needed

Route: IV push

Pedi dose: 0.02mg/kg IV


  • Matt says:

    “Asystole – 1mg MR q 3-5 minutes (total max. dose 3mg)”

    What’s MR?

  • medicscribe says:

    That’s got to be a typo. I’m going to remove it.



  • Ruth says:

    “may repeat”

  • medicscribe says:

    Thanks Ruth. I’ve added it back with your explanation.

  • lebogang says:

    above where you share the best bradycardia said the patient skin was cold clammy,no pressure,pulse at 20’s……..what you mean when you say no pressure? u wanted to say no readable blood pressure or no pulse pressure

  • medicscribe says:

    When I say no pressure, I mean I can’t hear anything when I take a manual blood pressure and/or the machine can’t read a blood pressure. A better word to use would have been heart rate is 20. You could say if I could feel a pulse, their blood pressure was at least 70. The point of the post was you are dealing with a severely symptomatic bradycardia. Thanks for the comment.

  • Jen Lyons says:

    Atropine is NOT for asystole. Epi is the ONLY thing we can push for flatlines.

  • Jen Lyons says:

    Also, for organophosphate poisoning it’s a way higher dose between 10-20mg

  • David Bowden says:

    People have widely varying tolerances for Atropine. While there are no absolute contraindications in OPP, 10-20 mg may very well kill someone. 1-2mg, while not likely to be effective on true organophosphate poisoning, is a much better dose to repeat until symptoms resolve, than to jump to 20 mg. I could “maybe” get on board with an initial 10mg in the presence of SLUDGE and /or DUMBELS and a source, with additional 1-2 mg doses every few minutes.

    *Disclaimer: I’ve never actually encountered organophosphate poisoning, and if I did, I didnt recognize it. I am speaking from a theoretical perspective: however, as an example of the varying tolerances I have seen 0.5 mg actually cause bradycardia in people.

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