B20: Cardiac Asystole

ECG: Cardiac Asystole
Cardiac Asystole

The EGG was recorded as a rhythm strip from a patient with acute myocardial infarction who suffered a cardiac arrest.

ECG. There is no record of any cardiac activity present. There is some baseline drift but no deflections that could represent cardiac activity are seen.

Comment. Cardiac asystole will be encountered during attempts at cardiopulmonary resuscitation. No circulation is present during asystole and basic life support must be instituted immediately. Treatment is less likely to be successful than when cardiac arrest is caused by ventricular fibrillation (VF) and it is essential that asystole is not confused with fine VF. Asystole may appear as a straight line on a monitor but usually there is some baseline drift or movement caused by artificial ventilation or cardiopulmonary resuscitation; these deflections may cause confusion with fine ventricular fibrillation. The gain settings on the monitor should be turned up and all electrical connections should be checked. All contact with the patient should cease briefly while the rhythm is checked. An additional EGG lead should be recorded where the monitor has the facility to change lead; if defibrillator paddles arc being used to monitor the rhythm the position of these should be altered. If any doubt remains that the rhythm might be fine ventricular fibrillation and not asystole, initial treatment should be with attempts at defibrillation.

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