Alright, our last arrest rhythm to talk about is asystole. It’s pretty straight forward to recognize because it’s just a big flat line.
There's no cardiac activity, there’s no QRS complexes, it’s just a flat line.
Asystole is treated largely the same as PEA. We're gonna perform CPR,
we're gonna give epinephrine 1mg every 3-5 minutes and we're gonna address the underlying cause.
The differential is the same as for PEA. In fact, all cardiac arrest regardless of rhythm will eventually degenerate to asystole.
We're gonna pay particular attention to oxygen and ventilation because those are reversible causes of asystolic arrest
and we're gonna make sure that we verified it really is asystole.
I can't tell you how many times I've seen one of leads fall off the patient’s chest
and it ends up tangled in the sheets or glued to the back board and then you end up thinking your patient is in asystole
when in fact you're trying to measure the electrical tracing of your stretcher, clearly not a good move.
The sad thing about asystole is it’s not really so much a disease to be treated.
Unfortunately, asystole is usually a confirmation of death.
So we wanna make sure that when we have a patient in asystole that we have addressed all the important points
that we've already discussed for managing cardiac arrest but ultimately,
we wanna consider terminating resuscitation when it’s appropriate.
So, bottom line on managing cardiac arrest is once again high quality continuous CPR for everybody,
it’s the most important thing you can do.
Two, cardiac rhythm dictates your appropriate management, so for patients in VFib and VTach you need to defibrillate
and we're also gonna use epinephrine and amiodarone, whereas for patient’s in PEA or asystole
we're gonna be giving epinephrine and also searching for the underlying cause of their cardiac arrest and attempting to reverse it.
At the end let’s have a short view on the post-arrest care.
Firstly you have to ensure appropriate oxygen levels with pulse oximetry.
Then - if the patient is hypotensive - treat him or her
with I V fluids and pressers, such as levophed, norepinephrine or dopamine.
If the patient has a pulse but is unarousable, then induce hypothermia
at temperatures between 32 and 36 degrees celsius.
If the patient is awake and follows your commands,
then you should get an E C G and treat the patient accordingly.
Then continue with evaluating the H's and T's.
The H's stand for hypovolemia, hypoxia, hydrogen ion - so this
means acidosis - hyper- or hypokalemia, and hypothermia.
The T's are toxins, tamponade - of course a cardiac tamponade -, tension pneumothorax,
trauma, and thrombosis.