ADULT

Asystole or PEA

Algorithm

New UPDATED 10/1/2020

Initiate an organized approach to CPR with responders in designated positions

 

 

 

 

PEA / Asystole:

CPR --- 0 minutes

Continue High Quality CPR without interruption unless pulse obtained

Witnessed Arrest - Consider passive ventilation for 6 min.

Un-witnessed Arrest - BVM / ETCO2 or Supraglottic airway unless:

ET indicated (Laryngeal edema from smoke inhalation)

Continue compression for approx. 2 min., then reassess

Place patient at 30 degrees - Semi-fowler if possible (ACCD)

Apply Automatic Chest Compression device when available before movement

 

►IV/IO vascular access without interruption of CPR

PEA / Asystole:

CPR --- 2 minute Reevaluate

Continue High Quality CPR without interruption unless pulse obtained

PEA / Asystole:

DRUG --- 3 minute Epi #1

Maintain CPR 2 min

Epinephrine 1 mg IV / IO (0.1 mg /1mL), approximately every 3-5 minutes

Maintain CPR

PEA Only:

Fluid Bolus --- 3 minute Fluid Bolus

250 mL NS bolus, may repeat to max of 1 liter to attain and maintain perfusion

→ Correct possible reversible causes:

Hypovolemia, acidosis, hypoxia, tension pneumothorax, hypothermia, toxins

PEA / Asystole:

CPR --- 4 minute Reevaluate

Evaluate the Patient for shockable rhythms

Continue High Quality CPR without interruption unless pulse obtained

PEA / Asystole:

CPR --- 6 minute Reevaluate

Evaluate the Patient for shockable rhythms

PEA / Asystole:

DRUG --- 7 minute Epi #2

Maintain CPR 2 min

Epinephrine 1 mg IV / IO (0.1 mg /1mL), approximately every 3-5 minutes

Maintain CPR

PEA / Asystole:

CPR --- 8 minute Reevaluate

Evaluate the Patient for shockable rhythms

PEA / Asystole:

CPR --- 10 minute Reevaluate

Evaluate the Patient for shockable rhythms

PEA / Asystole: 

INTUBATION --- 11 minute Intubation / Bicarb

Intubate with minimal interruption of CPR after 10 min of CPR

Sodium Bicarbonate 50 mL IV / IO

Maintain CPR

PEA / Asystole:

DRUG --- 12 minute Epi #3

Maintain CPR 2 min

Epinephrine 1 mg IV / IO (0.1 mg /1mL), approximately every 3-5 minutes

Maintain CPR

PEA / Asystole:

CPR --- 12 minute Reevaluate

Evaluate the Patient for shockable rhythms

PEA / Asystole:

CPR --- 14 minute Reevaluate

Evaluate the Patient for shockable rhythms

PEA / Asystole:

CPR --- 16 minute Reevaluate

Evaluate the Patient for shockable rhythms

PEA / Asystole:

DRUG --- 17 minute Epi #4

Maintain CPR 2 min

Epinephrine 1 mg IV / IO (0.1 mg /1mL), approximately every 3-5 minutes

Maintain CPR

PEA / Asystole:

CPR --- 18 minute Reevaluate

Evaluate the Patient for shockable rhythms

PEA / Asystole:

CPR --- 20 minute Reevaluate

Evaluate the Patient for shockable rhythms

Decision Point

1) Remain on scene and continue with treatment

2) Initiate transport to nearest ERC

3) Base Contact for further orders or pronouncement of patient in the field

RETURN OF SPONTANEOUS CIRCULATION (ROSC)

If prior to transport the pt develops a rhythm with pulse:
Make BHC for possible transport to Cardiovascular Receiving Center (CVRC)

 → Assess for and correct suspected:

Hypoxia, Hypovolemia, Hypoglycemia, and Hypothermia

D10 25 gm/250 mL (10% solution) IVPB / IO

If diabetic and hypoglycemia suspected:
(No D-stick, Non-Traumatic FA)

Epinephrine can be given with D10, there is no negative reaction

 

Interruption of chest compressions should always be held to a minimum.
Pads can be placed in the antero-lateral and antero-posterior positions;
For implanted pacemaker/defibrillator place pads to either side and not directly on top of the implanted device. For medication patch: remove patch, wipe area clean before attaching an electrode pad.

1:10,000 = 0.1mg/mL

1:1000 = 1mg/mL

Call

M: 949-769-1162

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