Asystole resident survival guide: Difference between revisions
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{{CMG}}; {{AE}} {{MS}} | {{CMG}}; {{AE}} {{MS}} | ||
== | ==Overview== | ||
Asystole is a state of no [[heart|cardiac]] electrical activity, hence no contractions of the [[myocardium]] and no cardiac output or blood flow. Asystole is also known as a cardiac arrest rhythm in which there is no distinct electrical activity on ECG. A (flat line) is another acronym for asystole. In asystole, the heart will not respond to [[defibrillation]] because it is already [[Depolarization|depolarized]]. | |||
==Causes== | ==Causes== | ||
| Line 11: | Line 12: | ||
===Common Causes=== | ===Common Causes=== | ||
*[[Hydrogen|'''H'''ydrogen]] ions ([[Acidosis]]) | |||
*[[Hyperkalemia|'''H'''yperkalemia]] or [[Hypokalemia|'''H'''ypokalemia]] | |||
*[[Hypoglycemia|'''H'''ypoglycemia]] | |||
*[[Hypothermia|'''H'''ypothermia]] | |||
*[[Hypovolemia|'''H'''ypovolemia]] | |||
*[[Hypoxia (medical)|'''H'''ypoxia]] | |||
*[[Cardiac tamponade|Cardiac '''T'''amponade]] | |||
*[[Tablets|'''T'''ablets]] or [[Toxins|'''T'''oxins]] ([[Drug overdose]]) | |||
*[[Tension pneumothorax|'''T'''ension pneumothorax]] | |||
*[[Thrombosis|'''T'''hrombosis]] ([[Myocardial infarction]]) | |||
*[[Thrombosis|'''T'''hrombosis]] ([[Pulmonary embolism]]) | |||
*[[Physical trauma|'''T'''rauma]] ([[Hypovolemia]] from blood loss) | |||
==Management== | ==Management== | ||
Below is an algorithm summarizing the approach to a patient with asystole. Based on the 2010 American heart association ACLS algorithm for asystole<ref name="pmid20956217">{{cite journal| author=Field JM, Hazinski MF, Sayre MR, Chameides L, Schexnayder SM, Hemphill R et al.| title=Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. | journal=Circulation | year= 2010 | volume= 122 | issue= 18 Suppl 3 | pages= S640-56 | pmid=20956217 | doi=10.1161/CIRCULATIONAHA.110.970889 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20956217 }} </ref> | |||
{{familytree/start}} | |||
{{familytree | | | | | | | | | | | | | | |A01 | | | | | |A01=Asystole<br>[[Image:Lead II rhythm generated asystole.JPG|350px|left|thumb]]}} | |||
{{familytree | | | | | | | | | | | | | | | |!| | | | | | | | }} | |||
{{familytree | | | | | | | | | | | | | | |B01 | | | | | |B01=Start CPR for 2 minutes<br>Give oxygen<br>Attach monitor and defibrillator<br>IV/IO access<br>Epinephrine Q3-5 min<br>Consider advanced airway, capnography}} | |||
{{familytree | | | | | | | | | | | | | | | |!|| | | | | | | | }} | |||
{{familytree | | | | | | | | | | | | | | |C01 | | | | | |C01=Rhythm}} | |||
{{familytree | | |,|-|-|-|-|-|-|-|-|-|-|-|-|^|-|-|-|-|-|-|.| }} | |||
{{familytree | | C01 | | | | | | | | | | | | | | | | | |C02|C01=Shockable|C02=Non-shockable}} | |||
{{familytree | | |!| | | | | | | | | | | | | | | | | | | |!| | | | | | | | }} | |||
{{familytree | |D01| | | | | | | | | | | | | | | | | |D02|-|-|-|-|-|-|-|.| |D01=See VF/VT algorithm|D02=CPR for 2 minutes<br>Treat Hs&Ts<br>Epinephrine Q3-5min}} | |||
{{familytree | | |!| | | | | | | | | | | | | | | | | | | |!| | | | | | | | |!| | | | | | | | | | | | | | |}} | |||
{{familytree | | |!| | | | | | | | | | | | | | | | | | | C01 | | | | | | | |!| | | | | | | | | | | | | | |C01=Rhythm}} | |||
{{familytree | | |!| | | | | | | | |,|-|-|-|-|-|-|-|-|-|-|^|-|-|-|-|.| | | |!| | | | | | | | |}} | |||
{{familytree | | |`|-|-|-|-|-|-|-|C1 | | | | | | | | | | | | | |C02|-|-|'| | | | | | |C1=Shockable|C02=Non-shockable}} | |||
{{familytree | | | | | | | | | | | |!| | | | | | | | | | | | | | | |!| | }} | |||
{{familytree | | | | | | | | | | |Z|-|-|-|-|-|-|-|-|-|-|-|-|-|-|'| | | | |Z=ROSC(return of spontaneous circulation}} | |||
{{familytree | | | | | | | | | | | |!| | | | | | | | }} | |||
{{familytree | | | | | | | | | | |Z1| | | | | | | | |Z1=Post–Cardiac Arrest Care }} | |||
{{familytree/end}} | |||
==Do's== | ==Do's== | ||
* Efficiency of CPR can be determined by | |||
**Monitoring of chest compression rate and depth | |||
**Adequacy of chest wall relaxation | |||
**Length and duration of pauses in compression and number and depth of ventilations delivered | |||
** Physiologic parameters; partial pressure of end-tidal CO2 [PETCO2], arterial pressure during the relaxation phase of chest compressions, central venous oxygen saturation [ScvO2] | |||
* Remember that the foundation of successful ACLS is good BLS , represented in prompt high-quality CPR with minimal interruptions.<ref name="pmid16982127">{{cite journal| author=Edelson DP, Abella BS, Kramer-Johansen J, Wik L, Myklebust H, Barry AM et al.| title=Effects of compression depth and pre-shock pauses predict defibrillation failure during cardiac arrest. | journal=Resuscitation | year= 2006 | volume= 71 | issue= 2 | pages= 137-45 | pmid=16982127 | doi=10.1016/j.resuscitation.2006.04.008 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16982127 }} </ref><ref name="pmid12010909">{{cite journal| author=Eftestøl T, Sunde K, Steen PA| title=Effects of interrupting precordial compressions on the calculated probability of defibrillation success during out-of-hospital cardiac arrest. | journal=Circulation | year= 2002 | volume= 105 | issue= 19 | pages= 2270-3 | pmid=12010909 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12010909 }} </ref> | |||
* A new class I recommendation is the use of quantitative waveform capnography for confirmation and monitoring of endotracheal tube placement. | |||
* Supraglottic advanced airways continues to be an alternative to endotracheal intubation for airway management during CPR. | |||
==Don'ts== | ==Don'ts== | ||
* Don't routinely use cricoid pressure during airway management of patients in cardiac arrest. | |||
* Don't routinely administer atropine in the management of pulseless asystole. | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{WikiDoc Help Menu}} | |||
{{WikiDoc Sources}} | |||
[[CME Category::Cardiology]] | |||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Medicine]] | [[Category:Medicine]] | ||
[[Category:Resident survival guide]] | [[Category:Resident survival guide]] | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Up-To-Date]] | [[Category:Up-To-Date]] | ||
[[Category:Up-To-Date cardiology]] | [[Category:Up-To-Date cardiology]] | ||
[[Category:Intensive care medicine]] | [[Category:Intensive care medicine]] | ||
Latest revision as of 20:31, 29 July 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahmoud Sakr, M.D. [2]
Overview
Asystole is a state of no cardiac electrical activity, hence no contractions of the myocardium and no cardiac output or blood flow. Asystole is also known as a cardiac arrest rhythm in which there is no distinct electrical activity on ECG. A (flat line) is another acronym for asystole. In asystole, the heart will not respond to defibrillation because it is already depolarized.
Causes
Life Threatening Causes
Asystole is a life-threatening condition and must be treated as such irrespective of the causes. Life-threatening conditions can result in death or permanent disability within 24 hours if left untreated.
Common Causes
- Hydrogen ions (Acidosis)
- Hyperkalemia or Hypokalemia
- Hypoglycemia
- Hypothermia
- Hypovolemia
- Hypoxia
- Cardiac Tamponade
- Tablets or Toxins (Drug overdose)
- Tension pneumothorax
- Thrombosis (Myocardial infarction)
- Thrombosis (Pulmonary embolism)
- Trauma (Hypovolemia from blood loss)
Management
Below is an algorithm summarizing the approach to a patient with asystole. Based on the 2010 American heart association ACLS algorithm for asystole[1]
Asystole | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Start CPR for 2 minutes Give oxygen Attach monitor and defibrillator IV/IO access Epinephrine Q3-5 min Consider advanced airway, capnography | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Rhythm | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Shockable | Non-shockable | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| See VF/VT algorithm | CPR for 2 minutes Treat Hs&Ts Epinephrine Q3-5min | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Rhythm | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Shockable | Non-shockable | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| ROSC(return of spontaneous circulation | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Post–Cardiac Arrest Care | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Do's
- Efficiency of CPR can be determined by
- Monitoring of chest compression rate and depth
- Adequacy of chest wall relaxation
- Length and duration of pauses in compression and number and depth of ventilations delivered
- Physiologic parameters; partial pressure of end-tidal CO2 [PETCO2], arterial pressure during the relaxation phase of chest compressions, central venous oxygen saturation [ScvO2]
- Remember that the foundation of successful ACLS is good BLS , represented in prompt high-quality CPR with minimal interruptions.[2][3]
- A new class I recommendation is the use of quantitative waveform capnography for confirmation and monitoring of endotracheal tube placement.
- Supraglottic advanced airways continues to be an alternative to endotracheal intubation for airway management during CPR.
Don'ts
- Don't routinely use cricoid pressure during airway management of patients in cardiac arrest.
- Don't routinely administer atropine in the management of pulseless asystole.
References
- ↑ Field JM, Hazinski MF, Sayre MR, Chameides L, Schexnayder SM, Hemphill R; et al. (2010). "Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 122 (18 Suppl 3): S640–56. doi:10.1161/CIRCULATIONAHA.110.970889. PMID 20956217.
- ↑ Edelson DP, Abella BS, Kramer-Johansen J, Wik L, Myklebust H, Barry AM; et al. (2006). "Effects of compression depth and pre-shock pauses predict defibrillation failure during cardiac arrest". Resuscitation. 71 (2): 137–45. doi:10.1016/j.resuscitation.2006.04.008. PMID 16982127.
- ↑ Eftestøl T, Sunde K, Steen PA (2002). "Effects of interrupting precordial compressions on the calculated probability of defibrillation success during out-of-hospital cardiac arrest". Circulation. 105 (19): 2270–3. PMID 12010909.