ADULT
Asystole or PEA
Algorithm
New UPDATED 10/1/2021
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)
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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
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PEA / Asystole:
CPR --- 2 minute Reevaluate
Continue High Quality CPR without interruption unless pulse obtained
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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
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PEA / Asystole:
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
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PEA / Asystole:
CPR --- 4 minute Reevaluate
Evaluate the Patient for shockable rhythms
Continue High Quality CPR without interruption unless pulse obtained
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PEA / Asystole:
CPR --- 6 minute Reevaluate
Evaluate the Patient for shockable rhythms
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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
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PEA / Asystole:
CPR --- 8 minute Reevaluate
Evaluate the Patient for shockable rhythms
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PEA / Asystole:
CPR --- 10 minute Reevaluate
Evaluate the Patient for shockable rhythms
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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
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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
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PEA / Asystole:
CPR --- 12 minute Reevaluate
Evaluate the Patient for shockable rhythms
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PEA / Asystole:
CPR --- 14 minute Reevaluate
Evaluate the Patient for shockable rhythms
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PEA / Asystole:
CPR --- 16 minute Reevaluate
Evaluate the Patient for shockable rhythms
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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
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PEA / Asystole:
CPR --- 18 minute Reevaluate
Evaluate the Patient for shockable rhythms
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PEA / Asystole:
CPR --- 20 minute Reevaluate
Evaluate the Patient for shockable rhythms
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Decision Point
1) Remain on scene and continue with treatment (After 30 minutes, choose option 2 or 3)
2) Initiate transport to nearest ERC
3) Base Contact for further orders or pronouncement of patient in the field
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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
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►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