Asystole/Pulseless Electrical Activity (PEA)

Check the patient’s Circulation, Airway, Breathing

Ensure 2 min of high quality CPR

Check equipment, cables, electrodes, check gain on the monitor

Confirm asystole in more than just 1 lead – Lead fall off is the #1 cause of Asystole in a hospital.

Secure the airway

Establish IV or IO with NS or LR

2 min high quality CPR

Vasopressor of choice given during CPR

Epinephrine 1.0 mg IV Q 3-5 min for the duration of the code

If Asystole continues give 2 min high quality CPR

Check the H’s and T’s  

Evaluate for and treat reversible causes anytime during the sequence

Hypovolemia                          Tension pneumothorax

Hypoxia                                  Tamponade (cardiac)

Hydrogen ion (acidosis)         Toxins

Hyper/Hypokalemia                Thromboemboli pulmonary    

Hypothermia                           Thromboemboli coronary       

  Team Leader: If PT asystole or other agonal rhythms remain constant after successful airway placement and initial ACLS medications and no reversible causes are identified, consider termination of resuscitative efforts.