Asystole

Section 4 - CARDIAC 4.02

ASYSTOLE

CONSIDER MEDICAL ETIOLOGY OF ASYSTOLE AND REFER TO APPROPRIATE PRACTICE PARAMETER:

• Hypoxia / acidosis, INITIAL MEDICAL CARE (2.01).
• Drug overdose, DRUG OVERDOSE / POISONING (5.05).
• Vagal Stimuli

When the Patient found in Asystole:

• Initiate 5 cycles of CPR (30:2) for approximately 2 minutes to allow blood to circulate and continue throughout resuscitation, minimizing interruptions. Assist ventilations with OXYGEN @ 100% via BVM. DO NOT HYPERVENTILATE.
• Reassess for circulation. Establish IV or IO.
• If HYPOTHERMIC, also follow HYPOTHERMIC PARAMETERS (5.06).
• Consider securing the airway king tube / intubation. Confirm tube placement with EtCO2. (a range 5-20 mmHg is indicative of low cardiac output)
• VASOPRESSIN 20 units IV / IO. (Alternate with) EPINEPHRINE 1:10,000 1 mg IV / IO (Vasopressin may be given twice) Continue EPINEPHRINE ever 3-5 minutes of arrest.
• ATROPINE SULFATE 1 mg rapid IVP or IO. Repeat every 3 - 5 minutes up to a total of .04 mg/kg.
• Apply TCP, set at maximum M-amp. If pulse generated, decrease dosage to setting which still maintains a palpable pulse. If unsuccessful, reattempt capture every 3 - 5 minutes as above.

Check for pulse and rhythm change after all interventions.

If suspected DRUG OVERDOSE (5.05)

• For calcium channel and beta-blockers, administer GLUCAGON 2 mg IVP, IN or IO May repeat x 1
• For calcium channel blockers, administer CALCIUM CHLORIDE 1 gram IVP or IO.
  • Avoid if patient is on digoxin or lanoxin.
• For tricyclic antidepressants (amitriptyline [Elavil], amoxapine, imipramine [Tofranil ], nortriptyline [Pamelor] and tetracyclic antidepressants (Remeron) OD, with wide QRS> 0.10 sec, administer SODIUM BICARBONATE 1 mEq/kg IVP. Repeat in 5-10 mins.
• For narcotic OD, Administer NALOXONE (NARCAN) 1 mg IVP, IN or IO

For patients with HYPERKALEMIA:

Suspect hyperkalemia in patients with any of the following: Diagnosis of Renal Failure or any form of kidney insufficiency, widening QRS, increased K+ in diet (excessive consumption of cherries, bananas, melons or citrus), acidosis, or shock. Note last dialysis TX.

• Administer CALCIUM CHLORIDE 1 gram IVP or IO. Avoid if patient is on digoxin or lanoxin.
• Administer SODIUM BICARBONATE 1 mEq/kg IVP or IO

Termination of efforts

In Medical Related Cardiac Arrests, the paramedic may terminate resuscitative efforts in Non-Hypothermic Adults provided all of the following criteria have been provided and established:

• Patient initially presents and maintains in Asystole. (Verified in 2 leads)
• Airway has been successfully controlled. (Not necessarily intubated)
• External pacing has been attempted and no palpable pulse was generated.
• VASOPRESSIN 20 units IVP has been administered and allowed time to circulate. x1
• ATROPINE SULFATE 1.0 mg rapid IVP/ IO has been administered and allowed time to circulate x1.
• EPINEPHRINE 1:10,000 1 mg IVP or IO has been administered & allowed time to circulate x1
• EtCO2 is (less than) < 20 mm Hg.

OR

• After 15 minutes of ALS with never having return of spontaneous circulation.

OR

• After the patients personal medical doctor agrees to sign the death certificate.