Treatment of Asystole (Nursing)

00:01 Hi, welcome to our video series on electrocardiogram.

00:05 On this one, we're going to talk about the treatment for asystole.

00:09 Now look at the normal sinus rhythm compared to asystole.

00:14 This one is really obvious that they are completely different, but let's review the obvious, why this strip is asystole.

00:24 Now the heart rate cannot be measured because there's no QRSs.

00:29 Why are there no QRS complex? Because in asystole, there is no electrical activity.

00:36 That's why we can't look at the rhythm because there's no electrical activity.

00:41 P waves, we can't see them because there's no electrical activity.

00:47 PR interval, we don't have any P waves, So we can't measure the PR because there's no electrical activity.

00:55 QRSs, again, no electrical activity.

01:00 Now you might be kind of annoyed like why did you have to say that multiple different times? What's going to make sense when we talk about why we don't defibrillator patients in asystole.

01:11 So here's what we can do with asystole.

01:15 CPR.

01:16 So we can do cardiopulmonary resuscitation.

01:20 If we can get advanced care to the patient, epinephrine can be given every 3 to 5 minutes during the code.

01:27 And then we do rhythm checks after 2 minutes or 5 cycles of CPR.

01:33 So anyone who's CPR trained in the community could perform CPR.

01:37 You would need someone who's specially trained to give the epinephrine every 3 to 5 minutes.

01:44 They would also have a monitor where we could check the rhythm every two minutes.

01:49 So let's get back to our question.

01:51 Why don't we use defibrillation with asystole? Well, we've got a little reminder up there in the graphic of what defibrillation is.

01:59 You see the two pads, those squares on the patient.

02:02 They have wires coming to them, those lead to a defibrillator.

02:06 Now the artist has put those yellow lines in there to remind us that that's where the electrical shock will travel through the heart.

02:13 The purpose of defibrillation is to kind of reset the heart, and you need to have a certain level of, let's call it electrical activity available in order for that to happen.

02:25 Now, let's talk in some little more science-y terms.

02:28 But the key takeaway point is defibrillation is not effective for asystole.

02:34 We can use it for pulseless V Tach, or V fib, but we do not use it for asystole.

02:43 Now let's talk a little bit more about why it's not effective for asystole.

02:49 Because the problem here, remember how many times we went back and said, there's no electrical activity? Well, in asystole, there is no electrical activity to be reset in the cardiac myocytes.

03:03 In a normal functioning heart, the myocytes are how the natural pacemaker function of the heart is used, and you have a coordinated contraction of atrium and ventricles, and atrium and ventricles when everything is coordinated and flowing smoothly.

03:20 Now, in order for that to happen, you have to have a controlled flow of ions and they go in and out of the cells, In ventricular fibrillation and ventricular tachycardia, there's an uncoordinated flow of ions, but they're still flowing.

03:36 So the cells are depolarizing, left and right and that's why they are fibrillating but remember, there's electrical activity there in V fib and V Tach, it's just not coordinated.

03:48 So you have atrium and ventricle are not working like they're supposed to.

03:52 You've got either, or you've got So that's the difference.

03:58 Defibrillating always tries to reset the ion flow in depolarization but it only works if there's already potential energy stored in those ion gradients.

04:09 With asystole, there is no potential energy in the myocytes, no ion gradients for the muscle cells to release all at once and that's how defibrillation works.

04:21 No electrical activity in asystole - no point in defibrillation.

04:27 Thanks for watching our video series today.