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Cardiology
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Sinus Bradycardia
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Atropine → pacing/chronotropes if unresponsive.
Decision
Outcome
Decision
Pulse <50, symptomatic. Initial actions?
✓
IV access, monitor, treat reversible causes (drugs, electrolytes, ischemia)
✗
Start dopamine drip immediately
Decision
Unstable features (hypotension, AMS, ischemic chest pain, AHF)?
✓
Yes → IV atropine 1 mg q3–5 min (max 3 mg)
✓
No → monitor and observe
Decision
Response to atropine?
✓
Inadequate → transcutaneous pacing OR dopamine 5–20 µg/kg/min OR epinephrine 2–10 µg/min
✓
Adequate → continue monitoring, treat cause
Outcome
Transcutaneous pacing/dopamine/epinephrine; transvenous pacing if persistent
AHA increased the atropine dose from 0.5 to 1 mg in the 2020 ACLS update.
Outcome
Monitor and address underlying cause