Cardiac Arrest – Non-shockable Rhythm

Last Updated on by cooltamil

Non-shockable Rhythm

What are two non-Shockable rhythms?

  • Pulseless electrical activity (PEA)
  • Asystole

In the case of non-Shockable rhythms cardiac arrest, what two interventions take immediate priority?

  • 2 minutes of CPR at a rate of 30:2
  • 1 mg adrenaline intravenously

What Reversible causes?

H and T

  1. Hypoxia
  2. Hypovolaemia
  3. Hyperkalaemia, hypokalaemia, hypoglycaemia, hypocalcaemia, acidaemia and other metabolic disorders
  4. Hypothermia
  5. Thrombosis (coronary or pulmonary)
  6. Tension pneumothorax
  7. Tamponade – cardiac
  8. Toxins



Calcium chloride 10 ml of 10% IV
Sodium bicarbonate 50 ml of 8.4% IV
Insulin-dextrose IV infusion (10 units of actrapid in 50 ml of 50% dextrose)


Potassium 20 mmol IV over 10 minutes followed by 10 mmol IV over 5-10 minutes
Also give magnesium 2 g IV if concurrent hypomagnesaemia suspected


Calcium chloride 10 ml of 10% IV
Also give magnesium 2 g IV if concurrent hypomagnesaemia suspected


Consider carbon monoxide poising- treatment O2. Specific treatment exists for cyanide poisoning (consider in those patients rescued from fires)

Opiate toxicity

Naloxone 0.4 mg IV; repeated doses up to 4 mg may be required

Tricyclic antidepressant toxicity

Sodium bicarbonate 50 ml of 8.4% IV

Local anesthetic toxicity

1.5 ml/kg of 20% lipid emulsion IV


Palpate the carotid pulse and look for signs of life for up to one minute
Re-warm patient to 32-34 oC
Withhold drugs until temperature >30 degrees celcius
If VF/VT persists beyond 3 shocks, withhold further shocks until temperature >30 degrees celcius


Intubate early and manange hypovolaemia with fluids and haemorrhage control


Consider a 50 mg bolus of alteplase if massive PE is thought to be the cause of cardiac arrest.

Tension pneumothorax

Any suspicion warrants needle thoracocentesis and, if fruitful, chest drain insertion.
Tension pneumothorax following central line insertion should also be considered.


Tamponade should always be considered following penetrating injury.
Thoracotomy is indicated within 10 minutes of the cardiac arrest
Bedside ultrasound should confirm a haemopericardium.


Intubate early


Manage by physically pushing the fetus to the left (left lateral no longer used) to relieve inferior vena cava (IVC compression)
If the fetus is >20 weeks gestation, emergency delivery via Caesarean section should occur within five minutes of cardiac arrest
If the fetus is <20 weeks it should not pose to much of a problem for resuscitation or place too many physiological demands on the mother and CPR can continue without Caesarian section

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