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Asystole

ACLS Asystole CASE

QuestionAnswer
After providing CPR for 2 minutes the rhythm check shows asystole. What steps take priority? IV/IO access (takes priority over advanced airway management unless bag mask ventilation is ineffective or arrest is due to hypoxia) and find and treat underlying cause
Define asystole. no discernable electrical activity – flat line
What must be ruled out when the rhythm appears to be asystole? Validate that the rhythm is true asystole by ruling out fine VF or operator error – check leads, power, settings
What are some reasons to stop or withhold resuscitative efforts? DNR orders, Rigor mortis, Threat to safety of providers
Discuss the prognosis for a patient in asystole. The prognosis for asystole is very poor. Most asystolic patients do not survive
When would prolonged resuscitation efforts be appropriate for the a patient in asystole because the condition offers a slightly better prognosis? In cases of hypothermia and drug overdose
Once IV/IO access has been established for the patient in asystole, what’s the next step? Give a vasopressor: Epinephrine 1mg q 3-5 minutes or replace first or second dose with 40 units vasopressin. Consider an advanced airway and capnography
Your patient in asystole has received vasopressor therapy and five cycles of CPR. Airway is intact. He is still in asystole. What’s next? Continue high quality CPR. Repeat Vasopressor therapy.
Your patient in aystole has received vasopressor therapy and five cycles of CPR. The next rhythm check shows electrical activity. What’s next? Palpate for pulse. If no pulse or questionable pulse continue CPR. If there is a good pulse and organized rhythm proceed to post cardiac arrest care
Your patient has been in asystole, reciveived vasopressor therapy and five cycles of CPR. The rhythm check now shows VF or VT. What’s next? Prepare to deliver a shock. Continue CPR while charging.
What are AHA recommendations for TCP and asystole? TCP is not recommended for asystole
What are the recommendations for defibrillation? If there is any question that the rhythm is fine VF then an initial shock is warranted
Who makes the decision to terminate resuscitative efforts in the hospital? The treating physician
What are the rules for terminating out of hospital resuscitative efforts? Continue efforts until: ROSC and spontaneous breathing; Transfer to senior Emergency response team, reliable criteria indicating irreversible death; safety or exhaustion of rescuer; DNAR order; online authorization from physician