Final answer:
In the case of symptomatic sinus bradycardia unresponsive to atropine and pacemaker, advanced cardiac life support measures with IV inotropic agents and possible transcutaneous pacing are next steps, while also addressing underlying causes.
Step-by-step explanation:
A patient with sinus bradycardia displaying symptomatic hypotension (blood pressure of 88/56 mmHg) and confusion, and unresponsive to atropine and pacemaker intervention, may require advanced cardiac life support (ACLS) measures.
Treatment options might involve the use of intravenous (IV) inotropic agents such as dopamine or epinephrine to increase heart rate and improve blood pressure. In some cases, transcutaneous pacing may be attempted if available and indicated. It's crucial to address the underlying causes, such as electrolyte imbalances, hypoxia, or metabolic issues, alongside symptomatic treatment. Persistent bradycardia unresponsive to medical therapy may necessitate the emergent insertion of a transvenous pacemaker under guidance from a cardiologist.