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Asystole or “flatline”

EKG Asystole Rhythm Strip

Asystole is not actually a true rhythm but rather is a state of no cardiac electrical activity. The main treatment of choice for asystole is the use of epinephrine and CPR.

Asystole is treated using the right branch of the puslesless arrest arrest algorithm. Click below to view the pulseless arrest algorithm diagram. When done click again to close the diagram.
Pulseless Arrest Algorithm Diagram.

During asystole, there is no blood flow to the brain and other vital organs. This results in very poor outcomes if resuscitation is successful.

If asystole is visualized on the monitor, you should ensure that all leads are connected properly. If all leads are properly connected, you should rapidly assess for any underlying causes for the asystole.

As with pulseless electrical activity (PEA), asystole can have possible underlying causes which can be remembered using the H’s and T’s mnemonic.

In the following video, asystole is depicted on the defibrillator monitor and suggestions for treatment are given. Please allow several seconds for the video to load.


Question: What can sometimes be mistaken for asystole during a code?
click here for answer

fine ventricular fibrillation

  72 Responses to “Asystole”

  1. I’m going to take my acls next week..im quite nervous since it is my first time to take this..im searching in the internet for a understandable tool for my study guide, and luckily i found this site .. im praying and hoping for a positive result..wish me luck..thanks..

    • Good luck to you with certification. You will do great!
      Make sure to use the checklist in the download library to ensure that you cover all of the material on the website. You can leave a comment on the home page to let me know how your certification goes.

      Kind regards,

  2. If rhythm on monitor is asystole do I have still to check pulse ? Or start CPR immediately.
    Checking rhythm on monitor alone is enough or we need to check pulse for PEA ?

    • A pulse check is always a good idea, but it should not take longer than 10 seconds. If you cannot feel a pulse within 10 seconds, start CPR.
      If you saw a rhythm change from pulseless VT or VF to asystole then you would not need to check for a pulse. You would continue CPR with rhythm checks between each 5 cycles of CPR.

      Kind regards,

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