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Asystole

Asystole .. Check me in another lead,


then lets have a cup of TEA.
A Intervention Comments!ose
T Transcutaneo
us "acin#
$TC"%
&nly e'ective (ith early
implementation alon# (ith
appropriate interventions and
medications.
)&TE* )ot e'ective (ith
prolon#ed do(n time.
E Epinephrine + m# I, -./0 min.
A Atropine + m# I, -./0 min. $ma1. dose
2.23 m#k#%
Consider termination of e'orts if asystole persists despite appropriate interventions.
Asystole may 4e discovered durin# the primary A5C! survey after attachin# a monitor, or it
may develop in a previously monitored patient. In either case, it is essential that asystole
4e con6rmed in another lead (ith properly functionin# e-uipment. If the patient is in true
asystole and is a candidate for resuscitation, then proceed (ith the secondary A5C!
survey.
Ventricular Fibrillation (VF)/
Pulseless Ventricular Tachycardia
(PVT)
The follo(in# mnemonic directs A7A accepted
actions after the primary survey ABCs
"lease 8hock/8hock/8hock, E,ery4ody 8hock,
And 9ets :ake "atients 5etter
Chant Intervention )ote
"lease
"recordial
Thump
:ay 4e performed immediately after determinin# pulselessness in
a (itnessed arrest (ith no de64rillator immediately availa4le.
Check pulse after thump.
8hock ;22<= If ,> or ,T is sho(n on monitor, shock immediately, do not lift
paddles from chest after shockin#, simultaneously char#e at ne1t
ener#y level and evaluate rhythm.
8hock ;22/.22<= If ,> or ,T persists on monitor, shock immediately, do not check
pulse, do not continue C"?, do not lift paddles from chest after
shockin#, simultaneously char#e at ne1t ener#y level and evaluate
rhythm.
8hock .@2<= If ,> or ,T persists, shock immediately.
Implement the secondary A5C! survey. !o not continue (ith this al#orithm if an
intervention results in the return of spontaneous circulation.
)&TE* Ahen #ivin# meds, do so in a dru#/shock/dru#/shock se-uence. Continue C"? (hile
#ivin# meds, and shock (ithin .2/@2 seconds. Evaluate the rhythm and check for a pulse in
the period immediately after shockin#.
Every4ody Epinephrine + m# I, -./0 min.
or
e,ery4ody ,asopressin 32 B I,, one time dose.$(ait +2/;2 minutes 4efore startin#
epi%
If ,>",T persists, C!"#$%&'( antiarrhythmics and sodium 4icar4.
CA)T$!"* Bsin# more than one antiarrhythmic may result in pro/arrhythmic dru#/dru#
interactions.
And Amiodarone $>irst
Choice%
.22m# I, push. :ay repeat once at +02m# in ./0 min.
$ma1. cumulative dose* ;.;# I,;3hrs.%
9ets 9idocaine +.2/+.0 m#k# I,. :ay repeat in ./0 min. $ma1. loadin#
dose* . m#k#%
:ake :a#nesium
8ulfate
+/; # I, $; min. push% for suspected hypoma#nesemia or
torsades de pointes.
"atients "rocainamide ;2 m#min, or +22 m# I, - 0 min. for refractory ,>. $ma1.
loadin# dose* +C m#k#%
Consider 4u'ers
5etter
5icar4onate + mE-k# I, for pree1istin# hyperkalemia, 4icar4/
responsive acidosis, some dru# overdoses, protracted
code $intu4ated%, or return of spontaneous circulation
after lon# code (ith e'ective ventilation
Bradycardia
All Trained !o#s Eat Iams
$The se-uence reDects interventions for increasin#ly severe 4radycardia%
Al#rth Intervention Comments!ose
All
Atropine 2.0/+.2 m# I, push - ./0 min. $ma1.
dose 2.2./2.23 m#k#%
Traine
d
TC" Bse Transcutaneous "acin# $TC"%
immediately (ith severely
symptomatic patients.
!o#s
!opamine 0/;2 E#k#min.
Eat
Epinephrine ;/+2 E#min.
Iams
Isoproterenol ;/+2 E#min.
#table Tachycardia
Think &/:/I, $pronounced oh my% &1y#en/:onitor/I,, even 4efore you start
your primary and secondary A5C! surveys. After the failure of one antiarrhythmic
dru#, electrical cardioversion is usually the ne1t treatment of choice. If the rate is
F+02 andor the patient is unsta4le (ith serious si#ns and symptoms due to the
rhythm, prepare for immediate electrical cardioversion.
)ote that amiodarone is listed for most of the sta4le tachycardias. Gno(in# the
e1ceptions for the use of amiodarone (ill aid in the implementation of the sta4le
tachycardia al#orithms.
Atrial Fibrillation/Flutter
$(ith(ithout C7>%
'ate Control diltiaHem
'hythm Conversion * )onemer#ent chemical or !C cardioversion should 4e
avoided, and (hen indicated, should only 4e performed 4y an e1perienced health
care provider after careful evaluation and throm4oem4olic precautions are taken.
+ol,-Par.inson-+hite
$(ith(ithout C7>%
$avoid adenosine, 4eta 4lockers, calcium channel 4lockers, di#o1in%
'ate Control amiodarone
'hythm Conversion )onemer#ent chemical or !C cardioversion should 4e
avoided, and (hen indicated, should only 4e performed 4y an e1perienced health
care provider after careful evaluation and throm4oem4olic precautions are taken.
"arro/ Comple0 Tachycardias
,a#al maneuvers
Adenosine
1unctional Tachycardia/&ctopic or 2ultifocal Atrial Tach (/ith//ithout C3F)
Amiodarone $no Cardioversion%
Paro0imal #upraventricular Tachycardia
"o C3F4
,erapamil
!C Cardioversion
Amiodarone
+ith C3F4
!C Cardioversion
di#o1in
amiodarone
diltiaHem
+ide-Comple0 Tachycardia/)n.no/n Type
$(ith(ithout C7>%
$avoid 4eta 4lockers, calcium channel 4lockers, di#o1in%
!C Cardioversion or amiodarone
Ventricular Tachycardia
!C Cardioversion or trial of medication
2onomorphic
$(ith(ithout C7>%
amiodarone
I
synchroniHed cardioversion
Polymorphic
Evaluate for electrolyte a4normality or dru# to1icity and treat accordin#ly
J
)ormal KTI 9on# KTI
Amiodarone ma#nesium
cardioversion overdrive pacin#
P&A
"ulseless Electrical Activity may 4e discovered durin# the primary A5C! survey
(hen a monitor is attached to a pulseless patient and a rhythm is sho(n. As part of
the secondary A5C! survey, a doppler should 4e used to con6rm pulselessness.
Interventions for pulseless electrical activity are #uided 4y the letters "/E/A*
Al5orth Comments/%ose
"ro4lem 8earch for the pro4a4le cause and
intervene accordin#ly.
Epinephrin
e
+ m# I, -./0 min.
Atropine Aith slo( heart rate, + m# I, -./0
min. $ma1. dose 2.23 m#k#%
#ynchroni6ed Cardioversion
#ynchroni6ed &lectrical Cardioversion
It is essential that AC98 "roviders kno( the indications for synchroniHed electrical
cardioversion and receive proper trainin# on the e-uipment their institution uses
4efore attemptin# to perform this intervention.
The follo(in# mnemonic directs preparations for synchroniHed electrical
cardioversion* !h #ay $t $snt #o
:nemoni
c
"reparation
&h
&; saturation monitor
8ay
8uction e-uipment
It
I, line
Isnt
Intu4ation e-uipment
8o
8edation and possi4ly
anal#esics
#ynchroni6ed &lectrical Cardioversion &ner5y 7evels4
Bnless other(ise speci6ed in the ta4le 4elo(, successive ener#y levels are =+22<,
and up to =;22<, =.22<, =.@2<, if needed. If the patients condition 4ecomes critical
and your e-uipment (ill not synchroniHe, then proceed (ith immediate
unsynchroniHed shocks.
'hythm #pecial "otes4
"olymorphi
c ,/tach
Treat polymorphic ,/tach like ,/64,
i.e., successive unsynchroniHed
shocks at =;22<, and up to =;22/.22<,
=.@2<, if needed.
"8,T, A/
Dutter
start (ith =02<
"ote* If ,/64 develops, immediately de64rillate follo(in# the ,> al#orithm.
=&r 4iphasic e-uivalent

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