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If you have a patient that is conscious and alert, with vitals of respirations 20, Heart rate 48 beats per minute and irregular, Blood Pressure 78/40, and spO2 94%, this patient is bradycardic and hypotensive. Since the patient is conscious, .5mg of atropine would be a good choice. If the patient became unconscious or the atropine was ineffective, transcutaneous pacing would be appropriate. The pacer would be started at 60 beats per minute. Also, the milliamps should start at 50. As the pacer is running, you would turn up the milliamps until the heart is captured. When there is consistent capture, depending on the intervals of the machine, turn up the milliamps 2-5 more to keep capture. Then the heart would be increased until sypmtoms improve. This is typically between 60-70 bpm.