Field medications · Adult & pediatric guidance · ALS
Atropine
Symptomatic bradycardia and organophosphate poisoning require different doses and pediatric rules.
OCEMS source summary · Updated 2026-09-16
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.
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.
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.