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Clinical picture of asystole depending on its duration

Treatment of complete A-V-block:

1. Medicamentous:

— atropine 0.1% 1.0 i/v every 3-4 hours;

— isadrin 5 mg sublingually every 3-4 hours or in the form of inhalations with 0.5-1% solution by 0.5-1.0 ml 3-4 times a day;

— alupent (y3-adrenomimetic) in ampules, tablets, aerosoles 2 doses every 4 hours or itrop (alupent) 1 ml i/v drop-by-drop per 500 ml 0.9% NaCl solution at the rate of 10-20 drops per min.;

— sodium lactate in ampules;

— glucocorticoids in significant doses with anabolic hormones;

— saluretics — lasix 40-60 mg i/v a day, hypothiazid with the purpose to preserve K⁺.

2. In ineffectiveness of medicamentous treatment a temporary, and later,
permanent cardiac stimulation is recommended. The temporary cardiac
stimulation is carried out by means of introducing one electrode through a
subclavian vein into the right atrium, and the other — into subcutaneous fat in
the region of the fourth intercostal space on the left, and they stimulate the
rhythm at the rate of 60-70 per min. The permanent cardiac stimulation is
carried out at HR less than 36 per min and ineffectiveness of medicamentous
therapy.

In case of APsyst drop lower than70 mm Hg, HR less than 36 per min and absence of conditions for installing a temporary cardiostimulator an emergency electroimpulsive therapy is carried on (200 kJ).

If it is impossible to carry out electroimpulsive therapy, the intracardiac or intravenous administration of 0.1% adrenalin hydrochloride solution 0.1-0.5 ml or 1-5 mg of alupent is indicated on the background of continuation of resuscitation measures.

Incomplete first-degree A-V block is characterized by prolongation of PQ>0.21 sec. (Fig. 37 d).

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