persistently bradycardic with hypotension, altered mentation, evidence of shock, ischemic chest discomfort, and/or acute heart failure, atropine 1mg intravenously may be considered [2]. Repeat dosing every 3–5min may be performed up to a maximum dose of 3mg. Atropine is a parasympatholytic drug that enhances AV nodal conduction and automaticity [5]. The efcacy of atropine for sinus bradycar­dia is supported by small nonrandomized studies with small populations [5–7]. Atropine was shown to increase heart rate above 60 bpm for most individuals included in these studies. One study reported that approximately 47% of patients had a complete or partial response to atropine treatment to achieve a heart rate ≥60bpm and systolic blood pressure ≥90 mmHg [5]. Of note, atropine will not improve AV block at the bundle of His, and some reports suggest worsened AV conduction and hemodynamic compromise [2]. Adverse effects of atropine include dry mouth, blurred vision, urinary retention, and altered mentation. If bradycardia is unresponsive to atropine, then transcutaneous pacing may be initiated and/or dopamine 2–10 mcg/kg/min or epinephrine 2–10 mcg/min continuous infusions titrated to response [2]. In refractory cases, transvenous pacing may be considered. Goals of therapy include correcting heart rate and preventing further hemodynamic instability. Monitor heart rate, blood pressure, electrocardiogram, symptoms, and adverse effects of interventional medications.