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After providing CPR for 2 minutes the rhythm check shows asystole. What steps take priority?
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Define asystole.
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Asystole
ACLS Asystole CASE
| Question | Answer |
|---|---|
| After providing CPR for 2 minutes the rhythm check shows asystole. What steps take priority? | IV/IO access (takes priority over advanced airway management unless bag mask ventilation is ineffective or arrest is due to hypoxia) and find and treat underlying cause |
| Define asystole. | no discernable electrical activity – flat line |
| What must be ruled out when the rhythm appears to be asystole? | Validate that the rhythm is true asystole by ruling out fine VF or operator error – check leads, power, settings |
| What are some reasons to stop or withhold resuscitative efforts? | DNR orders, Rigor mortis, Threat to safety of providers |
| Discuss the prognosis for a patient in asystole. | The prognosis for asystole is very poor. Most asystolic patients do not survive |
| When would prolonged resuscitation efforts be appropriate for the a patient in asystole because the condition offers a slightly better prognosis? | In cases of hypothermia and drug overdose |
| Once IV/IO access has been established for the patient in asystole, what’s the next step? | Give a vasopressor: Epinephrine 1mg q 3-5 minutes or replace first or second dose with 40 units vasopressin. Consider an advanced airway and capnography |
| Your patient in asystole has received vasopressor therapy and five cycles of CPR. Airway is intact. He is still in asystole. What’s next? | Continue high quality CPR. Repeat Vasopressor therapy. |
| Your patient in aystole has received vasopressor therapy and five cycles of CPR. The next rhythm check shows electrical activity. What’s next? | Palpate for pulse. If no pulse or questionable pulse continue CPR. If there is a good pulse and organized rhythm proceed to post cardiac arrest care |
| Your patient has been in asystole, reciveived vasopressor therapy and five cycles of CPR. The rhythm check now shows VF or VT. What’s next? | Prepare to deliver a shock. Continue CPR while charging. |
| What are AHA recommendations for TCP and asystole? | TCP is not recommended for asystole |
| What are the recommendations for defibrillation? | If there is any question that the rhythm is fine VF then an initial shock is warranted |
| Who makes the decision to terminate resuscitative efforts in the hospital? | The treating physician |
| What are the rules for terminating out of hospital resuscitative efforts? | Continue efforts until: ROSC and spontaneous breathing; Transfer to senior Emergency response team, reliable criteria indicating irreversible death; safety or exhaustion of rescuer; DNAR order; online authorization from physician |
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Perseverandovercome
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