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

2. AsystolE Treatment Algorithm Continue CPR Intubate at once Obtain IV access CONFIRM asystole in more than one lead

3. AsystolE Algorithm cont. Hypoxia Hyperkalemia Hypokalemia Hypothermia Preexisting Acidosis Drug Overdose Consider Possible Causes:

4. 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

5. 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.

6. What does AystolE look like?

7. 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

10. How do Epinephine and Atropine work? Epinephrine improves coronary and cerebral perfusion. Atropine increases the heart rate by blocking parasympathetic nervous system impulses.

11. 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

12. 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).

13. 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.

14. 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. 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.

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.

17. 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