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    1-1 Asystole

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    Jeremy Gartland
    Asystole is the complete absence of electrical activity in the heart muscle. It usually represents extensive damage to the heart tissue from lack of blood flow or an injury. Asystole is often a sign that death has already occurred rather than a treatable heart rhythm issue. Treatment involves CPR, establishing an airway, considering potential causes like drug overdose, hypokalemia or hypoxemia, and rapid transport to a hospital. The prognosis for asystole is generally very poor unless it is caused by a immediately reversible issue like choking and oxygen can be restored quickly.

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    1-1 Asystole

    Uploaded by

    Jeremy Gartland
    44 views16 pages
    Asystole is the complete absence of electrical activity in the heart muscle. It usually represents extensive damage to the heart tissue from lack of blood flow or an injury. Asystole is often a sign that death has already occurred rather than a treatable heart rhythm issue. Treatment involves CPR, establishing an airway, considering potential causes like drug overdose, hypokalemia or hypoxemia, and rapid transport to a hospital. The prognosis for asystole is generally very poor unless it is caused by a immediately reversible issue like choking and oxygen can be restored quickly.

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    1-1 Asystole (1)

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    Asystole is the complete absence of electrical activity in the heart muscle. It usually represents extensive damage to the heart tissue from lack of blood flow or an injury. Asystole is often a sign that death has already occurred rather than a treatable heart rhythm issue. Treatment involves CPR, establishing an airway, considering potential causes like drug overdose, hypokalemia or hypoxemia, and rapid transport to a hospital. The prognosis for asystole is generally very poor unless it is caused by a immediately reversible issue like choking and oxygen can be restored quickly.

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    44 views16 pages

    1-1 Asystole

    Uploaded by

    Jeremy Gartland
    Asystole is the complete absence of electrical activity in the heart muscle. It usually represents extensive damage to the heart tissue from lack of blood flow or an injury. Asystole is often a sign that death has already occurred rather than a treatable heart rhythm issue. Treatment involves CPR, establishing an airway, considering potential causes like drug overdose, hypokalemia or hypoxemia, and rapid transport to a hospital. The prognosis for asystole is generally very poor unless it is caused by a immediately reversible issue like choking and oxygen can be restored quickly.

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    Download as pptx, pdf, or txt
    of 16

    Continuing Education

    Asystole
    Definition: Asystole
    • Asystole is defined as the complete absence of electrical
    activity in the myocardium (heart muscle).
    • Usually this represents extensive myocardial ischemia
    (insufficient blood supply) or infarct (damaged tissue), with a
    very grim prognosis.
    • Most often, asystole represents a confirmation of death as
    opposed to a dysrhythmia requiring treatment.
    Additional Information
    • Unless Appendix C (cessation of resuscitation) applies, the
    team leader must consider the differential diagnosis while
    beginning and maintaining CPR and interventions.
    • Asystole should not be defibrillated, as the increased vagal
    tone may prevent resuscitation. If able to do so, rescuers
    should confirm asystole when faced with a “flat line” on the
    monitor.
    • One should always consider these possible causes of asystole
    and manage accordingly: drug overdose, hypokalemia,
    hypoxemia, hypothermia, and pre-existing acidosis.
    Additional Information
    • Asystole can be primary or secondary.
    • Primary asystole occurs when the heart's electrical system
    intrinsically fails to generate a ventricular depolarization.
    • This may result from ischemia or from degeneration (i.e.,
    sclerosis) of the sinoatrial (SA) node or atrioventricular (AV)
    conducting system.
    • Primary asystole usually is preceded by a bradydysrhythmia
    due to sinus node block-arrest, complete heart block, or both.
    Causes
    • Reflex bradyasystole/asystole can result from:
    • ocular surgery
    • retrobulbar block
    • eye trauma
    • direct pressure on the globe,
    • maxillofacial surgery,
    • hypersensitive carotid sinus syndrome, or
    • glossopharyngeal neuralgia.
    • Episodes of asystole and bradycardia have been documented as
    manifestations of left temporal lobe complex partial seizures.
    Causes
    • Secondary asystole occurs when factors outside of the heart's
    electrical conduction system result in a failure to generate any
    electrical depolarization.
    • In this case, the final common pathway is usually severe tissue
    hypoxia with metabolic acidosis.
    • Asystole or bradyasystole follows untreated VF and commonly
    occurs after unsuccessful attempts at defibrillation.
    • This forebodes a dismal outcome.
    Morbidity and Mortality

    • Resuscitation is likely to be successful only if it is


    secondary to an event that can be corrected
    immediately, such as a cardiac arrest due to choking
    on food (a cafe coronary), and only if an airway can
    be established and the patient may be rapidly
    reoxygenated.
    • Occasionally, primary asystole can be reversed if it is
    due to pacemaker failure, which could be either
    intrinsic or extrinsic, and this is corrected
    immediately by external pacing.
    Assessment & Treatment Priorities

    1. Ensure scene safety and maintain appropriate body substance


    isolation precautions.
    2. Determine unresponsiveness, absence of breathing and
    pulselessness.
    3. Maintain an open airway with appropriate device(s), remove
    secretions, vomitus, initiate CPR (“push hard, push fast”, limit
    interruptions), and deliver supplemental oxygen, using
    appropriate oxygen delivery device, as clinically indicated.
    4. Continually assess level of consciousness, ABCs and Vital Signs.
    Assessment & Treatment Priorities

    5. Obtain appropriate S-A-M-P-L-E history related to event,


    including possible ingestion or overdose of medications,
    specifically calcium channel blockers, beta-blockers and / or
    digoxin preparations.
    6. Every effort should be made to determine the possible causes
    of asystole in the patient.
    7. Initiate transport as soon as possible, with or without ALS.
    Treatment Procedures
    Basic Procedures
    – NOTE: Inasmuch as EMT-Basics are unable to confirm the presence of Asystole,
    check patient for pulselessness and manage according to the following protocol:
    1. Early defibrillation
    a. Perform CPR until AED device is attached and operable.
    b. Use AED according to the standards of the American Heart
    Association or as otherwise noted in these protocols and other
    advisories
    c. Resume CPR when appropriate.
    2. Activate ALS intercept, if available.
    3. Initiate transport as soon as possible, with or without ALS.
    4. Notify receiving hospital.
    ALS Interventions: What to
    expect
    • CPR
    – CPR is used to circulate blood to the brain and heart
    • Placing an Airway
    – To ensure that CPR is delivering oxygen to the brain and
    heart
    • Medications
    – Used for various reasons
    ALS Medications Used in
    Asystole
    • Atropine
    • Parasympatholytic agent
    • Used to eliminate vagal influence (decreased HR due to
    Vagus Nerve stimulation) on SA and AV nodes.
    • Not effective for infranodal third-degree heart block.
    ALS Medications Used in
    Asystole
    • Epinephrine
    – Considered the single most useful drug in cardiac arrest.
    – Used to increase coronary and cerebral blood flow during
    CPR.
    – May enhance automaticity during asystole.
    – Can be used for bradycardia in adult and pediatric
    patients.
    Prognosis
    • Prognosis depends on the etiology of the asystolic rhythm, timing of
    interventions, and success or failure of advanced cardiac life
    support.
    • Generally, the prognosis is dismal and postcountershock asystole in
    particular has an even worse survival rate.
    • When no shock is advised in patients with unwitnessed cardiac
    arrest, there were no survivors in the Termination of Resuscitation
    study.
    • The most recent American Heart Association guidelines to improve
    cardiocerebral resuscitation (CCR) have validated studies showing
    improved outcomes in all adults with out-of-hospital cardiac arrest
    in ventricular tachycardia and ventricular fibrillation only.
    Massachusetts State Protocol

    • The Massachusetts State Protocol for Asystole is


    Here:
    – 1.1 Asystole (Cardiac Arrest)
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