In Adult Unstable Bradycardia, which intervention is specified to be used only if transcutaneous pacing is required?

• A. Etomidate: 10 mg IV/IO (If Transcutaneous Pacing is required)
• B. Normal Saline: 500ml
• C. Push-Dose Epinephrine (1:100,000): 1ml of 1:10,000 Epi/9ml NS
• D. Atropine: 1 mg IV

Answer: (A)

In unstable bradycardia, if transcutaneous pacing is going to be used, sedation is often needed to keep the patient comfortable during the pacing process. Etomidate is chosen for this scenario because it provides rapid, short-acting anesthesia with minimal effects on heart rate and blood pressure, making it safe to administer in a hemodynamically unstable patient while you establish temporary pacing. The dose given (10 mg IV/IO) is specifically for this purpose and is used only when pacing is required.

The other options are general treatments in bradycardia that aren’t conditional on whether pacing is needed. A fluid bolus helps with potential hypovolemia, regardless of pacing. Push-dose epinephrine and atropine address heart rate and perfusion but aren’t reserved for the pacing context.