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Asystole or PEA


New UPDATED 10/1/2019

Initiate or maintain CPR
► High-flow oxygen by BVM

►IV / IO vascular access without interruption of CPR

For PEA administer Fluid Bolus before other treatments
20 mL/kg NS bolus, may repeat twice to attain and maintain perfusion

If no immediate response to initial 250 mL Normal Saline bolus:

Epinephrine 0.01 mg/kg IV / IO (0.1 mg/mL) approximately every 3 minutes

→ Correct possible reversible causes:

hypovolemia, acidosis hypoxia, tension pneumothorax, hypothermia, toxins


→ If known diabetic and hypoglycemia suspected administer:
D10 25 gm/250 mL (10% solution) IVPB / IO (See Dosing / Age Chart Below)

If at any time develops rhythm with pulse:

Make BHC (CCERC preferred) for transport destination
For continued PEA or asystole:

→Maintain CPR and transport to nearest PRC or make Base Contact to: - Provide further resuscitation orders
- Request pronouncement of patient in the field


→Interruption of chest compressions should always be held to a minimum


→Agonal gasps are not adequate breathing and when accompanied with a pulseless state the patient should be considered to be in full cardiopulmonary arrest


Pediatric D10 Dosing - See I-20 Pediatric Medication Doses

1:10,000 = 0.1mg/mL

1:1000 = 1mg/mL

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