Atropine 0.5-1mg q3-5min up to 3mg
Avoid atropine in wide-complex bradycardia and consider chronotropes such as epinephrine, dobutamine, dopamine, isoproterenol
Consider transcutaneous vs transvenous pacing
IV fluids
Adult - D50W
Ped - 2.5mL/kg of D10W
Acts independently of<unk> -adrenergic receptors in cardiac tissue
Half-life is 20 min, thus, if effective, need to start drip quickly after bolus
Adult: 5 mg IV bolus over one minute  
Ped: 50mcg/kg
Rebolus if no response after 10 min
Effects persist for 10-15 min
If effective start infusion at:
Adult: 2-5 mg/hr
Ped: 70 mcg/kg/hr
Tachyphylaxis occurs quickly with glucagon so frequent monitoring of heart rate and blood pressure is necessary as the drip might need to be uptitrated
Routine treatment with glucagon is not suggested as a sole antidote
Continuous drip is usually limited by insufficient quantities from pharmacy
Consider concurrent administration of ondansetron (causes nausea and vomiting)
Adult: 2-5 mg/hr
Ped: 70 mcg/kg/hr
Tachyphylaxis occurs quickly with glucagon so frequent monitoring of heart rate and blood pressure is necessary as the drip might need to be uptitrated
Continuous drip is usually limited by insufficient quantities from pharmacy
Consider concurrent administration of ondansetron (causes nausea and vomiting)<unk> -antagonism decreases intracellular calcium leading to smooth muscle relaxation; supplementation may reverse hypotension by increasing intracellular calcium levels
Calcium gluconate 3g (30-60mL of 10% soln)
Calcium chloride 1-3g IV bolus (10-20mL of 10% soln (requires large IV/central line)
Preferred over calcium gluconate because it provides triple the amount of calcium on a weight-to-weight basis 
Give Calcium 1g Q5min to titrate to BP effect
If effect in BP is seen can give as a drip at 10-50mg/kg/hr
Aim for calcium level of 14mg/dL and measure at least 30 minutes after administration
Preferred over calcium gluconate because it provides triple the amount of calcium on a weight-to-weight basis 
Give Calcium 1g Q5min to titrate to BP effect
If effect in BP is seen can give as a drip at 10-50mg/kg/hr
Takes 30-60 min for effect
Augments myocardial contraction leading to increased cardiac output
Regular Insulin 1 Unit/kg IV Bolus accompanied by 0.5 gram/kg dextrose
Regular insulin 1 Unit/kg/hr Drip, titrate infusion until hypotension is corrected or max 10u/kg/hr
D50W drip at 0.1-0.2 gram/kg/hr
Initial glucose checks q15 minutes until blood sugar stability established
Replace potassium and magnesium if necessary
Consider to be added as adjunctive therapy to all other therapies<unk>  can also be managed with vasopressors alone
Epinephrine
Adult: Start 1 mcg/min and titrate to MAP=60
Ped: Start 0.1mcg/kg/min
Adult: Start 1 mcg/min and titrate to MAP=60
Ped: Start 0.1mcg/kg/min
Bolus if QRS is wide
Sodium channel blockade from propranolol
Sodium channel blockade from propranolol
Magnesium if QT is prolonged
Sotalol known to prolong QT
Sotalol known to prolong QT
Draw all labs prior to infusion
Support as an antidote comes from animal studies and case reports
IV 20% Intralipid at 1.5 mL/kg Bolus
Bolus could be repeated 1-2 times if persistent asystole
Followed by infusion of 0.25 mL/kg/min for 30-60 minutes or until hemodynamic stability achieved
if responsive to bolus initiate infusion at 0.25 mL/kg/min for 1hr (e.g. about 600 mL over 30 minutes in a 70kg adult)
Infusion rate could be increased if the BP declines
Bolus could be repeated 1-2 times if persistent asystole
Followed by infusion of 0.25 mL/kg/min for 30-60 minutes or until hemodynamic stability achieved
Infusion rate could be increased if the BP declines
Only effective for nadolol, sotalol, and atenolol
Consider VA ECMO for refractory cases
Note that if ECMO is chosen, intralipids are avoided due to potential of clotting of the ECMO circuits
Consider ketamine as post-intubation sedation for hemodynamics
Beta-blocker toxicity
Cardiac
Clonidine toxicity
Inferior MI 
Digoxin toxicity
Sick sinus syndrome
Calcium channel blocker toxicity
Neurocardiogenic/reflex-mediated