NREMT Paramedic Cognitive ExamCardiology & ResuscitationEasy
A 75-year-old female is found unresponsive and pulseless. CPR is in progress. After 2 minutes of high-quality CPR, the rhythm check reveals a flat line on the cardiac monitor. What is the MOST appropriate next intervention?
- ADefibrillate immediately with 200 J (biphasic)
- BAdminister atropine 1 mg IV
- CContinue CPR for another 2 minutes and recheck rhythm
- DAdminister epinephrine 1 mg IV
Show answer & explanationAnswer & explanation
Correct answer: D. Administer epinephrine 1 mg IV
A flat line on the cardiac monitor in a pulseless patient indicates asystole, a non-shockable rhythm. The primary intervention for asystole, after confirming it in two leads and ensuring lead placement, is to continue high-quality CPR and administer epinephrine 1 mg IV/IO every 3-5 minutes.
Why the other options are wrong
- A. Defibrillation is only for shockable rhythms (VF/pVT), not asystole.
- B. Atropine is no longer recommended for asystole in current ACLS guidelines.
- C. While CPR is continuous, epinephrine should be administered during the CPR cycle, not delayed until a further rhythm check.
Asystole Management
Asystole is a non-shockable cardiac arrest rhythm (a 'flat line' on ECG) requiring continuous high-quality CPR, epinephrine administration, and a diligent search for reversible causes.
- Confirm asystole in at least two different leads to rule out lead detachment.
- It is a non-shockable rhythm.
- Epinephrine 1 mg IV/IO is administered every 3-5 minutes.
- Focus on identifying and treating the 'H's and 'T's.
Memory trick: Asystole: Flat Line, Give Epi, Search for Cause!