|ECG Low voltage
|ECG Pathological Q waves
|ECG ST/T wave changes
|ECG short PR
|ECG Heart Block
|ECG Asystole and P wave asystole
|ECG QRS complex
|ECG ST segment
|ECG: QT interval
|ECG: Bundle branch blocks
|ECG Dominant R wave in V1
|ECG Acute Coronary Syndrome
|ECG Crib sheets
Victims of sudden cardiac arrest who present with asystole as the initial rhythm have an extremely poor prognosis (10% survive to admission, 0 % to 2% survival-to-hospital discharge rate
- Asystole accounts for 40%, of cardiac arrests
- Asystole represents the terminal rhythm of a cardiac arrest.
- Asystole typically results from decompensation of prolonged ventricular fibrillation arrest
- May occur after defibrillation of VF/VT
- GCS 3 No pulse not breathing
- Telemetry shows a flat line
- Rate: no ventricular activity seen or =6/min; so-called “P-wave asystole” occurs with only atrial
impulses present to form P waves
- Rhythm: no ventricular activity seen; or =6/min
- PR: cannot be determined; occasionally P wave seen, but by definition R wave must be absent
- QRS complex: no deflections seen that are consistent with a QRS complex
- Check lead placement to ensure not fine VF
- ABCDE, Give Oxygen, Commence CPR
- Ensure IV access (or consider intraosseous).
- Consider intravenous adrenaline/epinephrine 1mg IV or Vasopressin
- When considering terminating care of a patient in asystole, the rhythm should be confirmed in two separate leads
- If rhythm changes to VF/VT (shockable rhythm) Consider Immediate Defibrillation.
Go To VF/VT
- Atropine is no longer recommended by the American Heart Association (AHA) for asystole
Consider reversible causes
- Hypovolemia: consider rapid bolus of IV fluid. Check haemoglobin/hematocrit. If
anaemia or massive haemorrhage, give blood
- Hypoxia: Increase O2, to 100% high flow. Confirm connections. Check for
bilateral breath sounds. Suction ET tube and reconfirm placement. Consider
- Hydrogen ion (acidosis): If profound, consider Sodium Bicarbonate IV.
- Hypokalaemia: Give IV Potassium
- Hyperkalemia: Give Calcium Chloride and 50% Dextrose and Insulin 10 units IV. Monitor glucose. Also Sodium Bicarbonate IV
- Hypothermia: Active warming by forced air blanket, warm IV fluid, raise
room temperature. Consider cardiopulmonary bypass.
- Tension pneumothorax: Unilateral breath sounds, possible distended neck
veins and deviated trachea (late signs). Perform emergent needle
decompression (2nd intercostal space at a mid-clavicular line) than chest tube
placement. Call for a chest x-ray, but do NOT delay treatment.
- Tamponade (cardiac):Consider placing TOE or TTE to rule out tamponade.
Treat with pericardiocentesis.
- Toxins: Consider medication error. Confirm no infusions
running and volatile anaesthetic off.
- Thrombosis (both pulmonary and coronary): Consider TEE or TTE to evaluate the right ventricle.
Consider fibrinolytic agents or pulmonary thrombectomy