This document provides guidance on managing symptomatic bradycardia. It defines bradycardia and distinguishes between symptomatic and adverse bradycardia. For initial management, it recommends assessing ABCDE, obtaining an ECG, starting an IV, providing oxygen monitoring, calling for help, and identifying the cause. Patients with adverse features like shock, ischemia, syncope or heart failure require prompt treatment with atropine up to 3mg in doses of 500mcg every 3-5 minutes. If atropine is not effective, options include isoprenaline, adrenaline, or transcutaneous pacing, and transvenous pacing may be arranged. In some cases of digoxin toxicity, antibody fragments can be tried before