Asystole is commonly called flatline.  There is no mechanical or electrical activity of the heart. Asystole commonly follows pulseless Ventricular Tachycardia (VTach) and Ventricular fibrillation (VFib).  Life Threatening Emergency.  Victims of sudden cardiac arrest who present with asystole as the initial rhythm have an extremely poor prognosis (10% survive to admission, 0 to 2% survival-to-hospital discharge rate). Asystole represents the terminal rhythm of a cardiac arrest. (Jordan MR, Lopez RA, Morrisonponce D. Asystole. 2021 Jul 19. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 28613616.)


Heart Rate: 0

Rhythm: Flatline/ Asystole

P wave: nothing present

QRS Complex: nothing present

ST segment: nothing present

Check the Patient:

  • Level of Consciousness (likely unresponsive)
  • Verify no pulse is present Call for Help and begin CPR
  • Support Oxygenation and Ventilation 
  • Ensure the Monitor is Connected and applied correctly
  • Hypotension (no viable pressure)
  • Saturation: may be difficult to obtain

Cardiac Arrest

  • CPR (Beginning with Chest compressions)
  • 1mg of Epinephrine
  • No Shocks
  • No Antiarrhythmics
  • Think H's & T's

Reversible Causes: H's & T's 

  • Hypovolemia
  • Hyper/Hypocalemia
  • Hypo/Hyperthermia
  • Hydrogen Ions (Acidosis)
  • Toxins
  • Thrombosis (Pulmonary Emboli)
  • Tension Pneumothorax
  • Tamponade (Cardiac)
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