Download Adult Asystole / Pulseless Electrical Activity

Adult Asystole / Pulseless Electrical Activity
History
Signs and Symptoms
Differential
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Past medical history
Medications
Events leading to arrest
End stage renal disease
Estimated downtime
Suspected hypothermia
Suspected overdose
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Tricyclic
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Digitalis
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Beta blockers
Calcium channel blockers
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DNR, MOST, or Living Will
Decomposition
Rigor mortis
Dependent lividity
Blunt force trauma
Injury incompatible with
life
Extended downtime with
asystole
AT ANY TIME
YES
Return of
Spontaneous
Circulation
Criteria for Death / No
Resuscitation
Review DNR / MOST Form
NO
I
Begin Continuous CPR Compressions
Push Hard (≥ 2 inches) Push Fast (≥ 100 / min)
Change Compressors every 2 minutes
(Limit changes / pulses checks ≤ 10 seconds)
P
Cardiac Monitor
YES
Shockable Rhythm
Go to
Post Resuscitation
Protocol
Reversible Causes
Hypovolemia
Hypoxia
Hydrogen ion (acidosis)
Hypothermia
Hypo / Hyperkalemia
Hypoglycemia
NO
Search for Reversible Causes
Dialysis /
Renal Failure
Protocol
if indicated
IV Procedure
P
→
IO Procedure
Consider Normal Saline Bolus 500 mL IV / IO
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P
Tension pneumothorax
Tamponade; cardiac
Toxins
Thrombosis; pulmonary
(PE)
Thrombosis; coronary (MI)
Epinephrine (1:10,000) 1 mg IV / IO
Repeat every 3 to 5 minutes
Or
Vasopressin 40 units IV / IO
May replace first or second dose of epinephrine
Consider Chest Decompression Procedure
Discontinue
Resuscitation
Criteria for Discontinuation
YES
Follow
Deceased Subjects Policy
NO
Notify Destination or
Contact Medical Control
Protocol 11
Any local EMS System changes to this document must follow the NC OEMS Protocol Change Policy and be approved by OEMS
Adult Cardiac Section Protocols
Follow
Rhythm Appropriate
Protocol
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Hypovolemia (Trauma, AAA, other)
Cardiac tamponade
Hypothermia
Drug overdose (Tricyclic, Digitalis, Beta
blockers, Calcium channel blockers)
Massive myocardial infarction
Hypoxia
Tension pneumothorax
Pulmonary embolus
Acidosis
Hyperkalemia
Cardiac Arrest Protocol
Do not begin
resuscitation
Follow
Deceased Subjects
Policy
Pulseless
Apneic
No electrical activity on ECG
No heart tones on auscultation
Adult Asystole / Pulseless Electrical Activity
Adult Cardiac Section Protocols
Pearls
· Efforts should be directed at high quality and continuous compressions with limited interruptions and early
defibrillation when indicated. Consider early IO placement if available and / or difficult IV access
anticipated.
· DO NOT HYPERVENTILATE: If no advanced airway (BIAD, ETT) compressions to ventilations are 30:2. If
advanced airway in place ventilate 8 – 10 breaths per minute with continuous, uninterrupted compressions.
· Do not interrupt compressions to place endotracheal tube. Consider BIAD first to limit interruptions.
· Breathing / Airway management after 2 rounds of compressions (2 minutes each round.)
· Success is based on proper planning and execution. Procedures require space and patient access. Make room to
work.
· If no IV / IO, drugs that can be given down ET tube should have dose doubled and then flushed with 5 ml of Normal
Saline followed by 5 quick ventilations. IV/IO is the preferred route when available.
· Consider each possible cause listed in the differential: Survival is based on identifying and correcting the cause.
· Potential association of PEA with hypoxia so placing definitive airway with oxygenation early may provide benefit.
· PEA caused by sepsis or severe volume loss may benefit from higher volume of normal saline administration.
· Return of spontaneous circulation after Asystole / PEA requires continued search for underlying cause of cardiac
arrest.
· Treatment of hypoxia and hypotension are important after resuscitation from Asystole / PEA.
· Asystole is commonly an end-stage rhythm following prolonged VF or PEA with a poor prognosis.
· Sodium bicarbonate no longer recommended. Consider in the dialysis / renal patient, known hyperkalemia or tricyclic
overdose at 50 mEq total IV / IO.
· Discussion with Medical Control can be a valuable tool in developing a differential diagnosis and identifying possible
treatment options.
· Potential protocols used during resuscitation include Overdose / Toxic Ingestion, Diabetic and Dialysis / Renal
Failure.
Protocol 11
Any local EMS System changes to this document must follow the NC OEMS Protocol Change Policy and be approved by OEMS