Correct oxygenation and ventilation first; escalate persistent bradycardia with poor perfusion.
OCEMS source summary · Updated 2026-09-16
Key cautions & base contact
Base contact is required. Atropine does not replace oxygenation and ventilation.
The minimum 0.1 mg and maximum 0.5 mg apply to the bradycardia indication; organophosphate poisoning has a separate atropine regimen.
Assess perfusion
Look for altered mental status, hypotension, weak perfusion, or shock. Ensure the airway is open and rule out obstruction.
Assist breathing when needed with oxygen and BVM. Monitor rhythm, pulse, BP, and oxygen saturation; preserve a rhythm strip.
Heart rate below 60 with continued poor perfusion
If heart rate remains below 60/min despite oxygenation and ventilation, begin CPR and obtain IV/IO access.
Give epinephrine 0.01 mg/kg IV/IO using 0.1 mg/mL (0.1 mL/kg); may repeat every 3–5 minutes. Make base contact, pediatric-capable preferred.
If base contact cannot be established, the order lists atropine 0.02 mg/kg IV/IO for persistent symptomatic bradycardia, increased vagal tone, or primary AV block: minimum 0.1 mg, maximum 0.5 mg per dose; may repeat once.
Further support
Continued poor perfusion may require base-ordered transcutaneous pacing. Use the appropriate pediatric pads/placement under PR-110.
For suspected hypovolemia or dehydration, normal saline is 20 mL/kg IV/IO, maximum 250 mL per bolus; may repeat twice for three total boluses. Identify causes such as hypoxia, hypothermia, or medication effects.
If perfusion is adequate
Support ABCs and monitor closely. If room-air SpO₂ is below 95%, give high-flow mask oxygen or nasal cannula/direct blow-by at 6 L/min as tolerated.
Obtain a 12-lead and assess the cause. Contact base for destination and ALS escort. Document the response to ventilation before and after each intervention.