FIELD REFERENCE
Full criteria & treatment guidance
Indications
- Symptomatic bradycardia with poor perfusion, or suspected organophosphate/nerve-agent poisoning under the matching pathway.
Contraindications & local exclusions
- The cited atropine injection label lists no absolute contraindications. This does not authorize use without an OCEMS indication or waive route/population limits.
Precautions
- Tachycardia can worsen ischemia. Glaucoma, urinary retention, pyloric obstruction and thickened respiratory secretions are precautions in the injection label; they are not presented here as absolute contraindications.
- These are selected safety checks, not a complete prescribing monograph. Product labeling and OCEMS authorization answer different questions; confirm the actual product, patient population and applicable order.
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.
Pediatric weight table — Symptomatic bradycardia
- SO-P-045 pediatric dose: 0.02 mg/kg 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
- SO-P-085 pediatric dose: 0.02 mg/kg 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
- SO-P-085 pediatric dose: 0.1 mg/kg 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.
VISUAL FIELD REFERENCE
Adult atropine: select the indication
Adult & pediatric guidance · ALS
Adult doses only. Pediatric bradycardia and poisoning have separate regimens below.
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.
- Stop adult atropine dosing when pacing captures, as directed in SO-C-020.
- Do not make atropine the first response to hypoxic pediatric bradycardia.
Selected checkpoints; read the complete guide for criteria, exclusions, doses, and ongoing care. I-15 · I-20 · SO-C-020 · SO-P-045 · SO-M-050 · SO-P-085
UNDERSTAND THE CARE
Why the indication belongs in the medication read-back
Atropine appears in bradycardia and organophosphate pathways with different regimens. The pediatric bradycardia minimum and maximum should not be applied to poisoning by habit, nor should a poisoning dose be reused for a slow pulse. State the indication with the proposed dose.
Applying the guidance
Identify the actual concentration and calculate the measured volume from the correct regimen. In adult bradycardia, urgently needed pacing should not wait for access, and the order directs stopping atropine once pacing captures. In a child, initial oxygenation and ventilation and the contact conditions remain part of the pathway. Reassess clinical perfusion rather than reporting only the rate.
Dose, concentration and volume
Diagram text & teaching checkpoints
- Indication
- Bradycardia versus toxin exposure.
- Age-specific sequence
- Ventilation, pacing and contact conditions.
- Concentration
- Verify the actual formulation.
- Response
- Rate, pressure and clinical perfusion.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.
- I-15 — Adult / Adolescent Standing Order Drug Guide
- I-20 — Pediatric Medication Volume Dose by Weight
- SO-C-020 — Symptomatic Bradycardia - Adult/Adolescent
- SO-P-045 — Bradycardia - Pediatric
- SO-M-050 — Substance Overdose / Poisoning - Adult / Adolescent
- SO-P-085 — Substance Overdose / Poisoning - Pediatric
- Product label — ATROPINE SULFATE injection, solution
Select the indication before the concentration column
Atropine’s pediatric tables are separated for a reason: the bradycardia pathway and the IV and IM poisoning pathways do not share every dose constraint. Start with the indication and authorized route, then select the table. After that, read the concentration on the actual product and use the matching volume column.
A useful read-back names all three decisions: why atropine is being used, which route/regimen is authorized, and which concentration is in hand. This prevents a correct calculation from being attached to the wrong clinical pathway. The existence of two concentration columns is not an instruction to choose either product without reading its label.
Keep the treatment response tied to the original problem. In bradycardia, report circulation and symptoms together with the rate and pacing status. In a poisoning presentation, retain the exposure and respiratory findings in the report instead of documenting only a faster pulse. For pediatric bradycardia, the preceding oxygenation/ventilation, epinephrine and base-contact sequence remains part of care; the atropine table is not a standalone first-action algorithm.