AsystolE

1
AsystolE

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

Page 1-24 in ACLS book
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AsystolE Treatment Algorithm

• Continue CPR
• Intubate at once
• Obtain IV access
• CONFIRM asystole in more than one lead

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AsystolE Algorithm cont.

• Hypoxia
• Hyperkalemia
• Hypokalemia
• Hypothermia
• Preexisting Acidosis
• Drug Overdose

• Consider Possible Causes

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AsystolE Algorithm cont.

• 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

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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.
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What does AystolE look like?
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How do you CONFIRM the rhythm is AsystolE?

• CONFIRM rhythm in 2 leads
• Always check that your leads are attached

8
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).

9
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

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How do Epinephine and Atropine work?

• Epinephrine improves coronary and cerebral
  perfusion.

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

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Atropines 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

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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).

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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.

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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.

15
Dont assume that a shock cant make it worse.

• Defibrillation of asystole can knock out the
  natural pacemakers of the heart and destroy any
  chance of recovery.

16

• 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.

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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