After atropine has failed, what is the next authorized treatment for symptomatic bradycardia under REMAC?

For symptomatic bradycardia that does not respond to atropine, the next authorized treatment under REMAC guidelines is typically a dopamine infusion at 5 µg/kg/min. This dosage provides an effective means to increase heart rate and improve cardiac output by supporting the sympathetic nervous system, particularly in cases where bradycardia does not resolve with atropine administration.

Dopamine acts as an inotropic agent that can help stimulate the heart's pacemaking activity, especially beneficial when the bradycardia is due to poor perfusion or has a significant hemodynamic impact. The choice of 5 µg/kg/min is based on established protocols that aim to manage hypotension or symptomatic bradycardia effectively.

Other treatment options, while potentially relevant in specific scenarios, would not be the immediate subsequent step in this particular situation. For instance, transcutaneous pacing could also be employed, but it is typically indicated as a secondary measure, especially in cases where intravenous medications are ineffective or if the patient is not responding well to pharmacologic interventions.