# Atropine

Symptomatic bradycardia and organophosphate poisoning require different doses and pediatric rules.

Population: Adult & pediatric guidance. Scope: ALS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: I-15 revised March 31, 2026; I-20 revised March 26, 2026. Both implemented April 1, 2026. See linked condition-specific sources..
Canonical page: https://www.ocmedic.com/guides/atropine/
Official source: [I-15 — Adult / Adolescent Standing Order Drug Guide](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Check before giving

- Do not make atropine the first response to hypoxic pediatric bradycardia.
- Stop adult atropine dosing when pacing captures, as directed in SO-C-020.

## Source documents

- [I-15 — Adult / Adolescent Standing Order Drug Guide](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-15%20Adult%20SO%20Drug%20Guide%2004-2026.pdf#page=1)
- [I-20 — Pediatric Medication Volume Dose by Weight](https://www.ochealthinfo.com/sites/healthcare/files/2026-04/I-20%20Peds%20Drug%20Guide%2004-2026.pdf)
- [SO-C-020 — Symptomatic Bradycardia - Adult/Adolescent](https://www.ochealthinfo.com/sites/healthcare/files/2024-07/SO-C-20%20Bradycardia.pdf)
- [SO-P-045 — Bradycardia - Pediatric](https://www.ochealthinfo.com/sites/healthcare/files/2024-07/SO-P-45%20Bradycardia%20peds.pdf)
- [SO-M-050 — Substance Overdose / Poisoning - Adult / Adolescent](https://www.ochealthinfo.com/sites/hca/files/2021-10/SO-M-50%20Poisoning%20OD.pdf)
- [SO-P-085 — Substance Overdose / Poisoning - Pediatric](https://www.ochealthinfo.com/sites/healthcare/files/2023-09/SO-P-85%20OD%2010-2023.pdf)

## Use in OCEMS

- Use the indication-specific pathway: bradycardia is not the same regimen as organophosphate/nerve-agent toxicity.
- Adult symptomatic bradycardia includes a rate at or below 60/min with hypotension, poor perfusion, altered consciousness, chest pain, or dyspnea/pulmonary edema.

## Adult / adolescent

| Indication / route | Dose & limits |
| --- | --- |
| Symptomatic bradycardia | 1 mg IV/IO/IM. SO-C-020 permits repetition about every 3–5 minutes to a total of 3 mg; I-15 summarizes a 3-minute interval. |
| Organophosphate poisoning | 2 mg IV or IM; may repeat once under SO-M-050. |

## Pediatric

- SO-P-045 prioritizes oxygenation/ventilation, CPR when indicated, epinephrine, and base contact. If base contact cannot be established, atropine 0.02 mg/kg IV/IO is listed for persistent symptomatic bradycardia, increased vagal tone, or primary AV block: minimum 0.1 mg, maximum single dose 0.5 mg; may repeat once.
- SO-P-085 organophosphate pathway: 0.02 mg/kg IV, repeat once as needed; alternative 0.1 mg/kg IM, repeat in 5 minutes as needed, maximum single dose 2 mg.

## Pediatric weight table — Symptomatic bradycardia

- Source: SO-P-045. Dose rule: 0.02 mg/kg; route: IV/IO.
- 0.02 mg/kg IV/IO; minimum 0.1 mg, maximum 0.5 mg per dose. May repeat once.
- Prioritize oxygenation/ventilation and the pediatric bradycardia pathway. The standing order specifies atropine if base contact cannot be established for persistent symptomatic bradycardia, increased vagal tone, or primary AV block.
- Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.
- Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice.
| Exact weight | Dose — IV/IO | Volume at 0.1 mg/mL | Volume at 1 mg/mL |
| --- | --- | --- | --- |
| 3 kg | 0.1 mg | 1 mL | 0.1 mL |
| 4 kg | 0.1 mg | 1 mL | 0.1 mL |
| 5 kg | 0.1 mg | 1 mL | 0.1 mL |
| 6 kg | 0.12 mg | 1.2 mL | 0.12 mL |
| 8 kg | 0.16 mg | 1.6 mL | 0.16 mL |
| 10 kg | 0.2 mg | 2 mL | 0.2 mL |
| 12 kg | 0.24 mg | 2.4 mL | 0.24 mL |
| 15 kg | 0.3 mg | 3 mL | 0.3 mL |
| 20 kg | 0.4 mg | 4 mL | 0.4 mL |
| 25 kg | 0.5 mg | 5 mL | 0.5 mL |
| 30 kg | 0.5 mg | 5 mL | 0.5 mL |
| 35 kg | 0.5 mg | 5 mL | 0.5 mL |
| 40 kg | 0.5 mg | 5 mL | 0.5 mL |
| 45 kg | 0.5 mg | 5 mL | 0.5 mL |
| 50 kg | 0.5 mg | 5 mL | 0.5 mL |
| 60 kg | 0.5 mg | 5 mL | 0.5 mL |

## Pediatric weight table — Organophosphate poisoning — IV

- Source: SO-P-085. Dose rule: 0.02 mg/kg; route: IV.
- 0.02 mg/kg IV; may repeat once as needed. SO-P-085 lists a maximum single dose of 2 mg. This indication does not use the bradycardia maximum of 0.5 mg.
- The IV and IM regimens differ. SO-P-085 also permits its listed medications by IO.
- Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.
- Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice.
| Exact weight | Dose — IV | Volume at 0.1 mg/mL | Volume at 1 mg/mL |
| --- | --- | --- | --- |
| 3 kg | 0.06 mg | 0.6 mL | 0.06 mL |
| 4 kg | 0.08 mg | 0.8 mL | 0.08 mL |
| 5 kg | 0.1 mg | 1 mL | 0.1 mL |
| 6 kg | 0.12 mg | 1.2 mL | 0.12 mL |
| 8 kg | 0.16 mg | 1.6 mL | 0.16 mL |
| 10 kg | 0.2 mg | 2 mL | 0.2 mL |
| 12 kg | 0.24 mg | 2.4 mL | 0.24 mL |
| 15 kg | 0.3 mg | 3 mL | 0.3 mL |
| 20 kg | 0.4 mg | 4 mL | 0.4 mL |
| 25 kg | 0.5 mg | 5 mL | 0.5 mL |
| 30 kg | 0.6 mg | 6 mL | 0.6 mL |
| 35 kg | 0.7 mg | 7 mL | 0.7 mL |
| 40 kg | 0.8 mg | 8 mL | 0.8 mL |
| 45 kg | 0.9 mg | 9 mL | 0.9 mL |
| 50 kg | 1 mg | 10 mL | 1 mL |
| 60 kg | 1.2 mg | 12 mL | 1.2 mL |

## Pediatric weight table — Organophosphate poisoning — IM

- Source: SO-P-085. Dose rule: 0.1 mg/kg; route: IM.
- Alternative route: 0.1 mg/kg IM; maximum 2 mg per dose. May repeat after 5 minutes as needed.
- Calculated examples for the exact weights shown, using the named standing-order/procedure formula. Do not round the patient’s weight to the nearest row. For another weight, calculate from the stated formula and apply the limits. These are not the rounded I-20 weight-band volumes.
- Volumes are mathematical examples rounded to at most three decimal places. Verify the vial concentration, dose, and measurable syringe volume before administration; follow agency preparation/rounding practice.
| Exact weight | Dose — IM | Volume at 1 mg/mL |
| --- | --- | --- |
| 3 kg | 0.3 mg | 0.3 mL |
| 4 kg | 0.4 mg | 0.4 mL |
| 5 kg | 0.5 mg | 0.5 mL |
| 6 kg | 0.6 mg | 0.6 mL |
| 8 kg | 0.8 mg | 0.8 mL |
| 10 kg | 1 mg | 1 mL |
| 12 kg | 1.2 mg | 1.2 mL |
| 15 kg | 1.5 mg | 1.5 mL |
| 20 kg | 2 mg | 2 mL |
| 25 kg | 2 mg | 2 mL |
| 30 kg | 2 mg | 2 mL |
| 35 kg | 2 mg | 2 mL |
| 40 kg | 2 mg | 2 mL |
| 45 kg | 2 mg | 2 mL |
| 50 kg | 2 mg | 2 mL |
| 60 kg | 2 mg | 2 mL |

## Preparation & reassessment

- Check concentration: the inventory permits different atropine formulations, and I-20 includes more than one concentration row.
- If adult pacing is urgently needed, do not wait for vascular access. Reassess rate, perfusion, and blood pressure.