Recent research indicates that electrical shocks can stun the heart in asystole and produce a profound parasympathetic discharge, making a return to normal rhythm even less likely. Some other, potentially correctable, causes of asystole are hypoxia, hyperkalemia, hypokalemia, preexisting acidosis, drug overdose, and hypothermia. Asystole is resistant to resuscitative efforts because the heart and other organs are profoundly ischemic. Once you verify asystole, quickly check for potentially correctable causes. As you recall, epinephrine improves coronary and cerebral perfusion.
Atropine increases the heart rate by blocking parasympathetic nervous system impulses.
Transcutaneous pacing can be started quickly without a physician present and is minimally invasive. Electrodes applied to the patient's skin deliver an electrical impulse that's conducted through the chest wall and myocardium. Some defibrillator units are equipped as TCP units. If TCP is successful, it can be used until a transvenous pacemaker can be inserted or until the underlying cause of the asystole can be identified and corrected. You suspect that Mrs. Chambers' asystole is caused by her hyperkalemia.