2-1 ASYSTOLE-PEA

Any patient requiring ACLS care should have an ALS intercept if logistically possible

EMR - Emergency Medical Responder

1. Establish unresponsiveness and PNB status
2. Provide CPR as outlined in the Adult Cardiac Arrest: Cardio-Cerebral Resuscitation Protocol
3. Call for ALS intercept
4. Prepare for transport

EMT- Emergency Medical Technician  perform/confirm all above interventions

Assure ALS intercept is en route

1. Reassess PNB status, continue Adult Cardiac Arrest: Cardio-Cerebral Resuscitation Protocol
2. Transport as early as possible, continuing resuscitation
3. Apply ECG monitor & run strip (if trained, if time allows and after all other interventions are completed)
4. Perform 12-lead ECG (if trained) as indicated

CONTACT MEDICAL CONTROL

AEMT – Advanced Emergency Medicine Tech   Perform/Confirm All Above Interventions

1. Initiate IV/IO NS, if approved, after 3rd analysis or sooner if possible, without interrupting CPR give NS fluid bolus, 500 mL wide open (do not delay transport)
2. CONTACT MEDICAL CONTROL
3. Administer additional NS fluid bolus, as directed

Intermediate  perform/confirm all above interventions

1. Attach cardiac monitor if not already done, confirm asystole in more than 1 lead
2. Administer epinephrine every 3-5 minutes
   1. 1 mg of 1:10,000 IV /IO -OR-
   2. 2 mg 1:1,000 ETT
3. Reassess rhythm every 2 minutes with changes in CPR provider or anytime ECG rhythm changes
4. Insert Advance Airway (Non-visualized or ETT) if not already done & confirm placement via capnography
5. If pulse regained at any time, reassess rhythm & go to appropriate algorithm CONTACT MEDICAL CONTROL
6. If persistent asystole, consider quality of resuscitation and termination

Paramedic  perform/confirm all above interventions

CONTACT MEDICAL CONTROL

1. Consider adjunct ACLS medications or antidotes
2. Consider causes to focus treatment
   1. H’s & T’s: Hypovolemia, Hypoxia, H+ acidosis, Hypo/Hyperkalemia, Hypoglycemia, Hypothermia, Toxins, Tamponade, Tension pneumothorax, Thrombosis (coronary, pulmonary), Trauma