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ASYSTOLE or PULSELESS ELECTRICAL ACTIVITY (PEA) Assess CAB’s and Begin CPR E Attach monitor / defibrillator Tips for successfully managing this case: Administer Oxygen Continue CPR in 2 minute cycles Stop briefly every 2 min to assess â [Secondary procedures] Secure Airway & Establish IV or IO with NS or LR during CPR â Given during CPR Epinephrine 1mg (as soon as possible) Continue CPR â Give Epinephrine Q 3 - 5 min Continue CPR While searching for reversible causes: â Evaluate for & treat reversible causes anytime during the sequence Hypoxia Hypovolemia Hydrogen ion (acidosis) Hyper/Hypokalemia Hypothermia Toxins (overdose) Thrombosis - Pulmonary Thrombosis – Coronary Tamponade - (Cardiac) Tension Pneumothorax â *If patient remains in asystole or other agonal rhythms after successful airway control and initial medications and no reversible causes are identified, consider termination of resuscitative efforts < Don’t forget: § Continue CPR throughout § Monitor for effective CPR Use ETCo2 § 2” compression § Full recoil § No rush to intubate § Start/upgrade IV or IO § Gather focused history Primary goal: continue effective CPR followed by rotating medications. *Verbalize appropriate drug, dose, route, flush, and reevaluate patient every 2 minutes. Once a rhythm is restored, maintain ventilations as appropriate then stabilize in order: 1. Rate 2. Rhythm 3. Blood pressure E To work on Asystole or PEA: Think DEAD: Do CPR, Epi, And, Do it again or Think PEA (for both PEA and Asystole) Push Epi And… Consider the cause 29