The technique of managing asystole. High-dose or standard-dose epinephrine: which is better?
Early, aggressive treatment is essential if patients with asystolic cardiac arrest are to survive. To maximize chances for success, use a five-phase protocol. Phase I: Confirm the diagnosis with a series of checks. Phase II: Intubate and hyperventilate the patient with 100% oxygen. Use an end-tidal carbon dioxide (ETCO2) detector to confirm tracheal intubation. Phase III: Initiate therapy with 1 mg of epinephrine and 1 mg of atropine. Consider defibrillation with a 360-wsec shock to reverse occult ventricular fibrillation. Phase IV: Repeat doses of epinephrine and atropine every 3 minutes. Phase V: Reevaluate the patient's chances of survival. If ETCO2 levels are undetectable or barely detectable (below 0.5%), survival is unlikely.
Slovis
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CM
Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
Wrenn
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KD
D002985:Clinical Protocols; D003657:Decision Making; D004837:Epinephrine / Q000008:administration & dosage*; D006323:Heart Arrest / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D008991:Monitoring, Physiologic / Q000379:methods; D012151:Resuscitation / Q000379:methods