■ Unresponsive state
■ ECG shows flat line; no electrical activity
1. Establish unresponsiveness with no respiration or pulse.
2. Begin CPR with high-flow oxygen.
4. Consider and treat possible causes: pulmonary embolism, MI, acidosis, tension pneumothorax, hyper- or hypokalemia, cardiac tamponade, hypovolemia, hypoxia, hypothermia, drug overdose (e.g., cyclic antidepressants, beta blockers, calcium channel blockers, digoxin).
5. If condition remains unchanged, begin immediate transcutaneous pacing if equipment is available.
6. Administer epinephrine 1 mg (10 mL of 1:10,000) IVP, repeat every 3-5 min; give 2.0-2.5 mg diluted in 10 mL normal saline if administering by ET tube.
7. Administer atropine 1 mg IVP, repeat every 3-5 min as needed, to a total dose of 0.03-0.04 mg/kg. May be given by ET tube at 2-3 mg diluted in 10 mL normal saline.
8. If no response, consider sodium bicarbonate 1 mEq/kg IVP, may repeat 0.5 mEq/kg every 10 min.
9. If asystole persists, consider quality of resuscitation, identification of reversible causes, and support for termination protocols.
y Clinical Tip: Do not delay transcutaneous pacing; it takes priority over medication.
y Clinical Tip: Always confirm asystole by checking the ECG in two different leads. Also, search to identify underlying VF.
y Clinical Tip: Study local policy to learn established criteria for stopping resuscitation efforts.
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Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...