Asystole - But are they really DEAD?

I can give a scientific view to Asystole.

In Asystole your patient's heart is DEAD, Zero electrical activity.  So, Let's Prove It!

There is a difference between discontinuity and a real Rhythm on the monitor.

A Flat Line is usually never real, check LEADS.

Asystole is defined as a cardiac arrest rhythm in which there is no discernible electrical activity on the ECG monitor. Asystole is sometimes referred to as a “flat line.” Confirmation that a “flat line” is truly asystole is an important step in the ACLS protocol.

  1. Put in a new Compressor

  •  Switching out to a fresh Compressor gives you a baseline for the compressions. This will get you good compression's for at least the next minute.

    • During Compression's (with new Compressor) check for Carotid & Femoral Pulses. Pulses don't have to be great but, THEY MUST BE PRESENT, or the compression's are useless to the patient.

      • If you don't feel pulses, start fluids immediately, 200-500 ml NS, over 1 minute.

  1. Has anyone checked the Rectum?  It may sound funny, but it's not a Joke.

    •  A diaper can hold 2 liters of blood and you would never know, unless you look.  If the patient isn't wearing a diaper, well then theres nothing in the way to help you see all that blood if  they are bleeding out.

      • This doesn't change what your doing but, it may explain why your not going to be successful.

        • Think a little; Bright Red Blood in the diaper or coming out the rectum; 

  • A GI bleed is usually a slow process, and now your pushing on their chest.  
  1. Check the IV/IO line?   If the asystole is real, FLUIDS may be your only reversible cause at this point.
  • Make sure the IV line is patent and flows freely.  If the line has infiltrated, then it's useless.
    • An Intraosseous access line will not even flow without a pressure bag attached.
    • Unless your pushing fluids manually, Use a pressure bag!
  1. Did the patient get what you intended to administer?
    • If the fluids aren't getting to the patient, you won't be very successful with asystole.
      • Epinephrine 1 Mg in 10 ml of every 3 minutes.
  1. Did you make a change in the patient with the above steps?​​​​​​

    • Anything is better that asystole.  What's on the cardiac monitor?

      • Ventricular Fibrillation: Great Job, don't forget to defibrillate.

      • PEA (Pulse Electrical Activity); Again, Great Job; Your patient MAY have a chance.

        • PEA is the precursor to asystole. So, to get PEA after asystole, your going in the right direction.

        • With PEA, give another Fluid Bolus 500 ml NS.l.

  2. If you still have asystole; well, you didn't make them any worse.

    • , Then GOTO Step 1 and do it again.

      • Your getting closer to Proving the asystole may be real.

After doing the above twice with the same results, you can conclude, it’s not you or your actions, but that the patient is REALLY in asystole.


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