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Extra resources for ABC of Resuscitation
At this stage it is important to exclude the presence of atrial fibrillation. This is a common arrhythmia occurring before cardiac arrest and often in the post-resuscitation period. In atrial fibrillation the ventricular response is irregular, unlike the regular ventricular pattern seen with other rhythms that arise above the AV junction. At faster ventricular rates it may be difficult to determine whether the rhythm is regular because the variation in the R-R interval, which is a feature of atrial fibrillation, becomes less pronounced.
All contact with the patient should cease briefly to reduce the possibility of interference. An alternative ECG lead should be 16 If the ECG appears as a straight line the leads, gain, and electrical connections must be checked Ventricular asystole. Persistent P waves due to atrial depolarisation are seen Asystole and pulseless electrical activity recorded when the monitor has the facility to do this, or the defibrillator monitor electrodes should be moved to different positions. On occasions, atrial activity may continue for a short time after the onset of ventricular asystole.
Resuscitation 2000;46:73-91. International Advisory Group on Resuscitation ALS Working Group. The universal algorithm. Resuscitation 1997;34:109-11. Page RL, Joglar JA, Kowal RC, Zagrodsky JD, Nelson LL, Ramaswamy K, et al. Use of automated external defibrillators by a US airline. N Eng J Med 2000;343:1210-15. Resuscitation Council (UK). Immediate life support manual. London: Resuscitation Council (UK), 2002. Robertson CE, Steen P, Adjey J. European Resuscitation Council. Guidelines for adult advanced support.
ABC of Resuscitation by Anna Donald, Andrew Haines, Beckinham, Grundy, David Grundy, Andrew Swain