ACLS Bradycardia 2 — Questions and Answers
Question 1: A patient presents with a heart rate of 38 bpm, hypotension, and altered mental status. Which drug is the FIRST-LINE treatment for symptomatic bradycardia?
- Epinephrine
- Atropine (Correct answer)
- Amiodarone
- Adenosine
Correct answer: Atropine
Atropine 1 mg IV is the first-line drug for symptomatic bradycardia in ACLS guidelines.
Question 2: What is the maximum cumulative dose of atropine recommended in ACLS for bradycardia?
- 1 mg
- 2 mg
- 3 mg (Correct answer)
- 4 mg
Correct answer: 3 mg
The maximum cumulative dose of atropine is 3 mg (given as repeated 1 mg doses every 3–5 minutes).
Question 3: A patient with symptomatic bradycardia fails to respond to atropine. Which of the following is the NEXT best step?
- Administer adenosine 6 mg IV
- Begin transcutaneous pacing (Correct answer)
- Give calcium chloride 1 g IV
- Perform synchronized cardioversion
Correct answer: Begin transcutaneous pacing
Transcutaneous pacing is the recommended intervention when atropine fails to improve symptomatic bradycardia.
Question 4: Which rhythm is most likely to be UNRESPONSIVE to atropine therapy?
- Sinus bradycardia
- Second-degree AV block Mobitz type I
- Third-degree AV block with wide QRS escape (Correct answer)
- Junctional bradycardia
Correct answer: Third-degree AV block with wide QRS escape
Complete heart block with a wide-complex (ventricular) escape rhythm is below the AV node and does not respond to atropine.
Question 5: During transcutaneous pacing for bradycardia, what confirms electrical capture?
- Patient reports chest discomfort
- Pacing spikes visible on the monitor
- Widened QRS complexes after each pacing spike with a pulse (Correct answer)
- Increased heart rate on the pulse oximeter waveform only
Correct answer: Widened QRS complexes after each pacing spike with a pulse
Electrical capture is confirmed by a pacing spike followed by a wide QRS, and mechanical capture is confirmed by a palpable pulse.
Question 6: An ACLS provider considers dopamine infusion for a bradycardic patient. What is the correct dose range for dopamine when used for rate support?
- 1–2 mcg/kg/min
- 2–10 mcg/kg/min (Correct answer)
- 10–20 mcg/kg/min
- 20–50 mcg/kg/min
Correct answer: 2–10 mcg/kg/min
Dopamine at 2–10 mcg/kg/min provides chronotropic and inotropic effects useful in symptomatic bradycardia.
Question 7: A patient with bradycardia has no symptoms — normal blood pressure, no chest pain, no altered mentation. What is the appropriate ACLS action?
- Immediate transcutaneous pacing
- Administer atropine 1 mg IV now
- Observe and monitor; no immediate intervention required (Correct answer)
- Perform synchronized cardioversion
Correct answer: Observe and monitor; no immediate intervention required
Asymptomatic bradycardia does not require treatment; ACLS intervention is indicated only when signs or symptoms are present.
ACLS Bradycardia 2
A patient presents with a heart rate of 38 bpm, hypotension, and altered mental status.
Which drug is the FIRST-LINE treatment for symptomatic bradycardia?