Acute Caremiddle twist
A 79-year-old woman is brought in drowsy and clammy after two episodes of collapse at home. The monitor shows complete heart block with a ventricular rate of 34 beats per minute and blood pressure is 68/40 mmHg. Her regular medicines are perindopril, atorvastatin and metoprolol. Atropine 0.5 mg intravenously has been given twice with no change in rate or blood pressure. Transcutaneous pacing pads are attached but repeated attempts at 130 milliamps fail to capture, and the cardiologist is 40 minutes away from being able to place a transvenous wire. Which one of the following should be started while she waits?