503-A ASYSTOLE

1. Perform Endotracheal Intubation. Oxygenate via Bag-Valve-Device or a manually operated resuscitator.

2. Begin an IV infusion of Dextrose 5 % in water (D5W) to keep vein open.

3. Administer Epinephrine 1.0 mg (10 ml of a 1:10,000 solution), IV bolus. As long as there is no change in the rhythm, repeat Epinephrine 1.0 mg (10 ml of a 1:10,000 solution), IV bolus, every 5 minutes.

4. Administer Atropine Sulfate 1.0 mg, IV bolus. If there is no change in the rhythm in 5 minutes, repeat Atropine Sulfate 1.0 mg, IV bolus. (Maximum total dosage is 2.0 mg.)

5. Contact Medical Control for implementation of one or more of the following Options:

MEDICAL CONTROL OPTIONS

OPTION A:

Administer Sodium Bicarbonate 88 mEq, IV bolus. Repeat doses of Sodium Bicarbonate 44 mEq, IV bolus, may be given every 10 minutes.

OPTION B:

Administer Calcium Chloride 250 mg, IV bolus.

OPTION C:

Administer Isoproterenol 2.0 mcg/min, IV drip. If there is insufficient improvement in hemodynamic status, the infusion rate may be increased until desired therapeutic effects are achieved or adverse effects appear. (Maximum rate is 10 mcg/min, IV drip.)

OPTION D:

Administer Glucagon 1. 0 mg, IV bolus.

OPTION E:

Defibrillate*.

• * Immediately following conversion to a supraventricular rhythm (even if only of a short duration), administer Lidocaine 1.0 mg/kg, IV bolus. Repeat doses of Lidocaine 0.5-1.0 mg/kg, IV bolus, may be given every 5 minutes up to a maximum dosage of 3.0 mg/kg, and may be followed by an IV drip at a rate of 1.0-4.0 mg/min. (Maximum individual dose is 100 mg and maximum total dosage is 225 mg.)

• NOTE:
  LIDOCAINE MUST BE USED WITH CAUTION IN PATIENTS OVER 70 YEARS OF AGE AND PATIENTS SUFFERING FROM CONGESTIVE HEART FAILURE, LIVER DISEASE, SHOCK (OF ANY ETIOLOGY), AND/OR POSSIBLE PRIOR ALLERGIC RESPONSE. PARAMEDICS SHOULD ALERT MEDICAL CONTROL TO THESE CONDITIONS, AS THE LIDOCAINE DOSAGE MAY NEED TO BE ADJUSTED ACCORDINGLY.

OPTION F:

Administer Dextrose 25 gm (50 ml of a 50% solution), IV bolus.

OPTION G:

Administer Naloxone 2.0 mg, IV bolus.

OPTION H:

Transportation decision.

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