What do you do when a patient is in asystole?

As a medical professional with expertise in emergency medicine, when encountering a patient in asystole, which is a life-threatening condition characterized by the absence of electrical activity in the heart, the following steps are critical: 1. Immediate Assessment: Confirm the patient's condition by checking for unresponsiveness and absence of pulse. 2. Call for Help: Activate emergency medical services (EMS) or inform the hospital team immediately. 3. Begin CPR: Initiate cardiopulmonary resuscitation (CPR) to maintain blood circulation. 4. Defibrillation: Although asystole is not typically shockable, check the rhythm with an AED or monitor to ensure no other rhythm is present that might require a shock. 5. Advanced Life Support (ALS): If available, proceed with ALS protocols, which include the use of medications like epinephrine and atropine, and other interventions as indicated. 6. Identify and Treat the Cause: Asystole can be caused by various factors such as electrolyte imbalances, hypothermia, or drug overdose. Identify and address the underlying cause if possible. 7. Continuous Monitoring: Keep monitoring the patient's vital signs and rhythm. 8. Pronouncement of Death: If efforts are unsuccessful and asystole persists, a decision may be made to stop resuscitation efforts based on local protocols and the patient's condition.

As soon as IV or IO access is available, administer epinephrine 1mg IV/IO. Do not stop CPR to administer drugs. During CPR, search for and treat possible contributing causes (see "Reversible Causes", H's and T's in the PDF version). If no electrical activity is present (patient is in asystole), resume CPR.