Atropine sulfate is a parasympatholytic (parasympathetic blocker). It blocks the vagal effects on the SA and AV nodes, which is to slow the SA node rate and reduce the conduction speed through the AV node. As a results of the vagal blockade, the heart rate and AV velocity increases.

.Administration of this drug can be performed by certified critical care nurses by Medical Directive. 

Ensure that patient and health care provider safety standards are met during this procedure including:

  • Risk assessment and appropriate PPE
  • 4 Moments of Hand Hygiene
  • Procedural Safety Pause is performed
  • Two patient identification
  • Safe patient handling practices
  • Biomedical waste disposal policies
  • Electrical safety
  1. Identify life-threatening rhythm
  2. Administration
  3. Notify physician
  4. Monitor for side effects

  5. Document

  6. Order requirement




Identify Life-Threatening Rhythm

A certified critical care nurse may give atropine by Medical Directive in the following circumstances:

1. Heart rate < 60 bpm and SBP < 90 mmHg


2. At least one sign or symptom related to the bradyarrhythmia (e.g. hypotension, decreased level of consciousness, chest pain, shock or congestive heart failure).

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 for supraventricular bradyarrhythmias.

Less frequently, atropine may cause paradoxical slowing of heart rate. Atropine is unlikely to be beneficial if conduction disturbance is below the AV node .

These conditions can be aggravated by parasympathetic blockade, therefore, DO NOT give atropine in Complete Heart Block.



An certified critical care nurse may administer a dose of Atropine 0.5 mg IV or Intraosseus (IO) direct by Medical Directive. 

The nurse may repeat with a second dose of 1 mg.  May repeat every 3 minutes up to a maximum total dose of 3 mg by Medical Directive.

Atropine may be given via ETT in the absence of vascular access. Give 2 X the IV dose down the ETT (1 mg followed by 2 mg for second dose).

Atropine increases heart rate through parasympathetic blockade.


Notify Physician

Notify the critical care physician. Further treatment of investigation may be required.

 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.



Document the 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

During a cardiac arrest, document the atropine in the cardiac arrest record.

When atropine is given outside a cardiac arrest situation, the certified critical care nurse enters the order and identifies "Medical Directive" as the authority. 

In an emergency situation where the cardiac arrest record is not being used, back sign for the atropine in the MAR. 



American Heart Association. 2015 & 2018 Integrated ACLS Guidelines

American Heart Association. 2020 ACLS highlights. 


Developed by:

Last Update:  November 5, 2018 (KK/BM), Updated: February 10, 2020 (KK/BM); Reviewed: January 21, 2021 (BM)