• Diagnose aystole correctly to ensure VF is not missed. Aystole can be confirmed by checking that leads are attached correctly and the rhythm is viewed through leads I or II. Increasing the gain on the monitor may also aid correct identification (for further detail refer to Chapter 8). If there is any doubt, follow the shockable side of the algorithm for VF (AHA & ILCOR 2000).

• Early identification and treatment will give the patient the best chance of survival (see later discussion). Continue resuscitation while identifying causes.

• Follow the 'right loop' of the algorithm. CPR is started immediately and carried out for three minutes. Manage the airway and ventilation and initiate IV access. Epinephrine 1mg is administered intravenously every three minutes. Administer atropine 3mg intravenously to give total blockade of the vagus nerve (Resuscitation Council UK 2000c).

• Check the ECG carefully for the presence of a P wave or slow ventricular activity. These rhythms may respond to cardiac pacing (AHA & ILCOR 2000).

During the treatment of PEA or asystole, the rhythm may change to VF/VT. Follow the shockable side of the algorithm if this happens.

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