What is Asystole?
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Article at a Glance
- Asystole is the absence of electrical and mechanical activity in the heart.
- The first intervention is always chest compressions.
- Epinephrine is the first-line medication for treating asystole.
- The provider should always assess for and treat reversible causes (Hs and Ts)
Asystole has nothing to do with the electrical activity on the monitor. Asystole means “without contraction” of the heart muscle. The heart is electrically silent and has no mechanical contraction. Essentially, it’s not working. You’ll see asystole as you progress through the adult cardiac arrest algorithm. If the rhythm isn’t shockable, it’s asystole or pulseless electrical activity (PEA). During asystole, the heart is not contracting. Providers use the MAP in other formulas to calculate other pressures throughout the body. It is also used as a guideline in certain treatment algorithms, such as the sepsis algorithm.Asystole
Related Video – Ventricular Rhythms and Asystole
Related Video – ECG Rhythm Review – Asystole
Treatment
During asystole, immediately begin chest compressions and administer a 1 mg epinephrine 1:10,000 IV push with a flush. Epinephrine is indicated because it may start a stopped heart.
Related Video – Epinephrine – ACLS Drugs
After you defibrillate the patient, begin chest compressions and administer epinephrine.
After defibrillating the patient, give chest compressions and IV epinephrine.
Asystole or PEA may occur right after defibrillation because the patient was in ventricular fibrillation (VF), and you shocked them into asystole unknowingly. That’s why the American Heart Association (AHA) recommends chest compressions and IV epinephrine immediately after defibrillation.
While asystole is usually a terminal event, you can hope to quickly find a treatable cause via the Hs and Ts.
Read: General Stroke Care
The Hs and Ts of asystole.
A patient in asystole has an electrically silent heart with no mechanical contractions. Providers may unknowingly shock patients into asystole, so the AHA recommends immediate chest compressions and IV epinephrine following defibrillation. While asystole can be a terminal event, check your Hs and Ts to find a treatable, reversible cause.Summary
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