For a 62-year-old patient with a heart rate of 30 and blood pressure of 70/40, what is the preferred sequence of interventions?

In this scenario involving a 62-year-old patient with a heart rate of 30 beats per minute and a blood pressure of 70/40 mmHg, the preferred sequence of intervention is to administer atropine followed by transcutaneous pacing.

Atropine is an anticholinergic medication that increases heart rate by inhibiting the vagus nerve's influence on the heart. In cases of symptomatic bradycardia, especially when the patient is experiencing hypotension (as indicated by the low blood pressure), atropine is a first-line treatment because it can quickly improve heart rate and blood pressure.

After administering atropine, if the patient's condition does not improve, or if there is a persistent need to stabilize the heart rate, transcutaneous pacing becomes the next intervention. This method provides immediate electrical stimulation to the heart, effectively managing severe bradycardia and stabilizing the patient's hemodynamics until further definitive treatment can be arranged.

This sequence prioritizes rapid improvement in the patient's condition by using pharmacological intervention first, followed by an immediate physical method to support cardiac function, making it an effective approach in emergency settings.