1.Primary ABCD survey2.Confirm asystole in two or more leads.
If rhythm isunclear and possible ventricular fibrillation, defibrillateas for VF.
3.Secondary ABCD survey4.Consider possible causes:
hypoxia, hyperkalemia,hypokalemia, hypothermia, preexisting acidosis, drugoverdose and myocardial infarction.
Consider transcutaneous cardiac pacing (ifconsidered, perform immediately)
Epinephrine 1.0 mg IVP, repeat every 3-5 minutes.
Atropine 1.0 mg IV, repeat every 3-5 minutes up tototal dose of 0.04 mg/kg.
If asystole persists, consider withholding or ceasingresuscitative efforts.
Before terminating resuscitative efforts considerquality of resuscitation, if atypical clinical featuresare present, or if support for cease-effortsprotocols are in place.
Pulseless Electrical Activity (PEA)
1.Pulseless electrical activity:
rhythm on monitor,without detectable pulse.
2.Primary ABCD survey3.Secondary ABCD survey4.Consider possible causes:
hypoxia, hypovolemia,hyper-/hypokalemia and metabolic disorders,hypothermia, hydrogen ion acidosis, tension pneumo-thorax, cardiac tamponade, toxic/therapeuticdisturbances (such as tricyclics, digitalis, beta-blockers, calcium channel blockers), pulmonaryembolism, and acute myocardial infarction.
Epinephrine 1 mg IVP, repeat every 3 to 5 minutes.
Atropine 1 mg IVP (if PEA rate less then 60 bpm),repeat every 3 to 5 minutes as needed, to a total doesof 0.04 mg/kg.
Slow (absolute bradycardia <60 bpm) or relatively slow(rate less than expected relative to underlyingconditions or cause).
2.Primary ABCD survey3.Secondary ABCD survey4.If unstable
(considered unstable if chest pain,shortness of breath, decreased level ofconsciousness, hypotension, shock, pulmonarycongestion, congested heart failure or acute MI arepresent) interventional sequence:
Atropine 0.5-1.0 mg IVP repeated every 3-5 minutesup to 0.04 mg/kg (denervated transplanted heartswill not respond to atropine, go immediately to TCP,catecholamine infusion or both).
Transcutaneous pacing (TCP) if available: if patientis symptomatic, do not delay TCP while awaiting IVaccess or atropine to take effect.
Dopamine 5-20 mcg/kg/min.
Epinephrine 2-10 mcg/min.
Isoproterenol 2-10 mcg/min
And not in type II or type III AV heart block, observe.
If in type II or type III AV heart block, prepare fortransvenous pacer or use transcutaneouspacemaker until transvenous pacer is placed.
1.Assess and evaluate patient.
Is patient stable orunstable? Are there serious signs and symptoms dueto tachycardia?
Consider unstable if chest pain, hypotension, CHF,myocardial infarction, ischemia, decreased level ofconsciousness, shock, dyspnea or pulmonarycongestion are present.
2.If unstable, prepare for immediate cardioversion.A.
Establish rapid heart rate as cause of signs andsymptoms. If ventricular rate is >150 bpm, preparefor immediate cardioversion.
Rate-related signs and symptoms seldom occur atrates <150 bpm. May consider brief trial ofmedications based on specific arrhythmias.Immediate cardioversion is generally not needed ifheart rate is <150 bpm.
oxygen saturation monitor, suctiondevice, IV line, intubation equipment.
Premedicate whenever possible.