Asystole

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Section 4 - CARDIAC 4.02

ASYSTOLE

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


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.

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.

Contact will be made in conjunction and compliance with Federal, State, Local, and Agency Laws and Policies regarding patient body care and removal.

A paramedic may decide to continue resuscitation efforts as outlined in these Practice Parameters. Reasons to continue may include scene safety, location, and input from present family members.

If patient combative post resuscitation, refer to ANALGESIA / SEDATION PARAMETER (2.04)