Under Medical Directive


Atropine sulfate is a parasympatholytic that blocks vagal effects on the SA rate and increases AV conduction. Administration of this drug can be performed by CCTC nursing staff who are approved in the administration of life saving drugs.

  1. Identify life-threatening rhythm
  2. Administration
  3. Notify physician
  4. Hand Hygiene
  1. Monitor for side effects
  2. Document
  3. Order requirement




Identify Life-Threatening Rhythm

The nurse identifies a life-threatening bradyarrhythmia that would respond to atropine:
• Heart rate < 60 bpm and
• At least one sign or symptom related to the bradyarrhythmia (e.g. hypotension, decreased level of consciousness, chest pain).

DO NOT give in complete heart block.

Contraindicated in patients with glaucoma, myasthenia gravis, asthma, obstructive diseases of GI tract, intestinal atony, obstructive uropathy.


Bradyarrhythmias should only be treated if symptomatic.
Atropine may restore normal AV conduction.

May cause paradoxical slowing of heart rate. Atropine unlikely to be beneficial if conduction disturbance below AV node .

These conditions can be aggravated by parasympathetic blockade.

    2.. Hand Hygiene        2. In accordance with the MoHLTC 4 moments of hand hygiene and LHSC infection control policies in an effort to reduce risk of transmission of microorganisms and secretions.



An approved nurse may administer a dose of Atropine 0.5 mg IV direct under medical directive.

An approved nurse may repeat the dose of atropine q3-5 minutes up to a maximum total dose of 3 mg under medical directive.


Atropine increases heart rate through parasympathetic blockade.


Notify Physician

Notify the critical care physician.


Further treatment may be necessary.

 5 .

Monitor Side Effects

Monitor for side effects of atropine.


Clinical signs and symptoms may include tachycardia causing myocardial ischemia, blurred vision, dry mouth, urinary retention or delirium.



The nurse documents administration and effect of atropine in the clinical record and medication administration record.


The CNO identifies the nurse as competent to perform this skill and accountable for practice. Documentation provides evidence of clinical decision making and activation of protocol driven practice under medical directive.


Order Requirement

The medical directive is the physician's order.



This skill delegates to the nurse the ability to make independent decisions and to implement actions according to protocol guidelines.


American Heart Association. (2000). Guidelines 2000 for cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 6: Advanced cardiovascular life support: 7D. The American Heart in collaboration with the International Liaison Committee on Resuscitation. Circulation, August 22; 102 (8 Supp).

Field, J.M., Hazinski, M. & Gilmore, D (Eds). (2006). Handbook of Emergency Cardiovascular Care for Healthcare Providers. American Heart Association.

Hazinksi, M., Chameides, L., Elling, B. & Hemphill, R. (2005-2006). Highlights of the 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Currents in Emergency Cardiovascular Care, Vol 16, 4, 1-28.

Developed by:
Judy Hackett RN BScN CCTC
Clinical Educator, CCTC
August 14, 2006
October 2006

Last Update:  April 7, 2010, revised September 29, 2014 (B.Morgan)

LHSCHealth Professionals

Last Updated September 29, 2014 | © 2007, LHSC, London Ontario Canada