What should be done immediately if there is no response to atropine in a symptomatic bradycardia patient?

In cases of symptomatic bradycardia, atropine is often administered as the first-line treatment to increase the heart rate. However, if there is no response to atropine, the next immediate step is to initiate transcutaneous pacing (TCP). TCP is a crucial intervention for patients with severe bradycardia who exhibit significant symptoms, such as hypotension, altered mental status, or signs of shock. It provides a temporary external pacing mechanism to restore an adequate heart rate and improve hemodynamic stability.

The other options, while potentially relevant in certain contexts, do not address the urgency of correcting the bradycardic state. Administering IV fluids may be beneficial in cases of accompanying hypovolemia but does not provide an immediate resolution to the bradycardia. Administering oxygen is essential for hypoxic patients but does not directly affect heart rate. Waiting for further orders could lead to a delay in treatment that could compromise the patient's condition, especially if they are symptomatic. Therefore, starting TCP is the appropriate immediate response when atropine is ineffective.