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AsystolE. Definition : Asystole is the absence of electrical activity in the myocardium. Page 1-24 in ACLS book. AsystolE Treatment Algorithm . Continue CPR Intubate at once Obtain IV access CONFIRM asystole in more than one lead. Hypoxia Hyperkalemia

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asystole

AsystolE

Definition: Asystole is the absence of electrical activity in the myocardium.

Page 1-24 in ACLS book

asystole treatment algorithm
AsystolE Treatment Algorithm
  • Continue CPR
  • Intubate at once
  • Obtain IV access
  • CONFIRM asystole in more than one lead
asystole algorithm cont
Hypoxia

Hyperkalemia

Hypokalemia

Hypothermia

Preexisting Acidosis

Drug Overdose

AsystolE Algorithm cont.

Consider Possible Causes:

asystole algorithm cont1
Consider immediate transcutaneous pacing (TCP)

Epinephrine 1mg IV push, repeat every 3-5 minutes

Atropine 1 mg IV, repeat every 3-5 minutes up to a total of 0.03-0.04 mg/kg

AsystolE Algorithm cont.
asystole algorithm cont2
AsystolE Algorithm cont.
  • Consider termination of efforts

Resuscitation efforts may cease when the patient has:

- been successfully intubated

- successful IV access

- adequate CPR

- all rhythm appropriate medications.

how do you confirm the rhythm is asystole
How do you CONFIRM the rhythm is AsystolE?
  • CONFIRM rhythm in 2 leads
  • Always check that your leads are attached
asystole represents what electrophysiologic condition
Asystole represents what electrophysiologic condition?
  • Total absence of ventricular electrical activity.
  • Aystole may occur as the primary rhythm or follow Ventricular Fibrillation or Pulseless Electrical Activity (PEA).
what drugs are used in the asystole algorithm
What drugs are used in the AsystolE algorithm?
  • Epinephrine
    • 1 mg IV push
    • repeat every 3-5 minutes
  • Atropine
    • 1 mg IV push
    • repeat every 3-5 minutes up to 0.03-0.04 mg/kg
how do epinephine and atropine work
Epinephrine improves coronary and cerebral perfusion.

Atropine increases the heart rate by blocking parasympathetic nervous system impulses.

How do Epinephine and Atropine work?
atropine s use during asystole
Atropine’s use during AsystolE
  • There is no sure proof of its value, but
  • There is little evidence that it is harmful
  • Less effective after prolonged ischemia or mechanical injury in the myocardium
difference of atropines use in aystole vs pea
Difference of Atropines use in AystolE vs PEA
  • Atropine is given in asystole to “speed up the heart”. There is no rate.
  • In PEA Atropine is only given if the rate is bradycardic (slow).
when should you consider transcutaneous pacing
When should you consider transcutaneous pacing?
  • External pacing should be considered as soon as possible
  • Pacing may help if it's initiated early and simultaneously with CPR and medications.
should you defibrillate asystole
Should you defibrillate AsystolE?
  • Be sure to check in two leads that the rhythm is not fine ventricular fibrillation.
    • In this case you would follow the V-Fib algorithm
  • No evidence that defibrillation is beneficial.
don t assume that a shock can t make it worse
Don’t assume that a shock “can’t make it worse”.
  • Defibrillation of asystole can knock out the natural pacemakers of the heart and destroy any chance of recovery.
slide16

Not all lethal arrhythmias can be successfully treated. But by being able to recognize them and respond appropriately in an emergency, you'll give your patients a better chance of survival.

references
References:
  • “Dealing Confidently with Lethal Arrhythmias”, Nursing 98 January 98
  • “Advanced Cardiac Life Support” American Heart Association 1997-99
  • “ACLS quick review Study Cards” Barbara Aehlert, RN, 1994