ASYSTOLE

Question 1

Immediate action with systole

Answer 1

1. Turn OFF vasodilating volatile & IV drips; Increase to 100% O2, high flow.
2. Ventilate 10 breaths/minute; do not over ventilate.
3. Ensure IV access (or consider intraosseous).
4. Epinephrine – 1 mg IV push q 3-5 minutes.
5. If rhythm changes to VF/VT (shockable rhythm) Immediate Defibrillation.
   Go To VF/VT, event #6.
6. Consider ECMO if available and reversible cause.
7. Consider TTE or TEE Echocardiography to evaluate cause.

Question 2

Assess CPR quality, improve IF:

Answer 2

• ETCO2 < 10 mmHg

* Arterial line Diastolic < 20 mmHg

Question 3

Consider common perioperative Ddx:

HASMAHAPLVP

Answer 3

1. Hemorrhage
2. Anesthetic overdose
3. Septic or other shock states
4. Medication error
5. Auto PEEP
6. High spinal
7. Anaphylaxis
8. Pneumothorax
9. Local anesthetic toxicity
10. Vagal stimulus
11. Pulmonary Embolus

Question 4

Hypovolemia:

Answer 4

Give rapid bolus of IV fluid.
Check hemoglobin/hematocrit. If anemia or massive hemorrhage, give blood.
Consider relative hypovolemia: Auto-PEEP (disconnect circuit); High Spinal; or Shock States (e.g. anaphylaxis). .

Question 5

Hypoxemia:

Answer 5

Increase O2, to 100% high flow. Confirm connections. Check for bilateral breath sounds.
Suction ET tube and reconfirm placement.
Consider chest X-ray.

Question 6

Tension pneumothorax:

Answer 6

Unilateral breath sounds, possible distended neck
veins and deviated trachea (late signs).
Perform emergent needle decompression (2nd intercostal space at mid-clavicular line) then chest tube
placement. Call for chest x-ray, but do NOT delay treatment.

Question 7

Thrombosis – Coronary:

Answer 7

Consider transesophageal (TEE) or transthoracic
(TTE) echocardiography to evaluate ventricle wall motion abnormalities of the ventricles.
Consider emergent coronary revascularization.

Question 8

Thrombosis – Pulmonary:

Answer 8

Consider TEE or TTE to evaluate right ventricle.

Consider fibrinolytic agents or pulmonary thrombectomy.

Question 9

Toxins (e.g. infusions):

Answer 9

Consider medication error.
Confirm no infusions running and volatile anesthetic off.
If local anesthetic toxicity Go To Local
Anesthetic Toxicity, event #17.

Question 10

Tamponade

Answer 10

Cardiac: Consider placing TEE or TTE to rule out tamponade.

Treat with pericardiocentesis.

Question 11

Hypothermia

Answer 11

Active warming by forced air blanket,
warm IV fluid
raise room temperature.
Consider cardiopulmonary bypass.

Question 12

Hyperthermia: If Malignant Hyperthermia, c

Answer 12

all for MH Cart. Give Dantrolene immediately: start at 2.5 mg/kg. MH Hotline: (800) 644-9737.

Question 13

Obtain ABG to rule out:
Hyperkalemia
CPR effectiveness so monitor)..

Answer 13

Give Calcium Chloride 1 g IV; D50 1 Amp IV

25 g Dextrose) + Regular Insulin 10 units IV. Monitor glucose. Sodium Bicarbonate 1 Amp IV (50 mEq

Question 14

Hypokalemia

Answer 14

Controlled infusion of potassium & magnesium.

Question 15

Hypoglycemia: If ABG delay, check Fingerstick.

Answer 15

Give D50 1 Amp IV

(25 g Dextrose). Monitor glucose.

Question 16

H+ Acidosis: If profound, consider Sodium Bicarbonate

Answer 16

1 Amp IV (50 mEq). May consider increasing ventilation rate (but can decrease)

Question 17

Hypocalcemia:

Answer 17

Give Calcium Chloride 1 g IV