Flatline Algorithm
(Verse 1) Monitor goes quiet, no spike, no wave Just a straight line staring back at the grave Pulseless, apneic, no tone in the chest No heart sounds left when I listen and press We run SAMPLE, history fast What led them here, what happened last? Estimated downtime, clock in my head How long they’ve been “almost dead” DNR, MOST, living will check tight Before we fight a losing fight And I see the clues that tell me when This one might not come back again (Pre-Chorus) Rigor, lividity, trauma unseen Decomposition telling me what’s been If it fits the signs, we don’t delay But if it’s not, we go full play (Chorus) Flatline life, but we don’t stop here CPR cuts through the fear 100 to 120, push and stay No more than ten seconds away Two inches deep, don’t lose that pace Change those hands, rotate the space EtCO₂ low, we push it hard In this silence, we guard the yard (Verse 2) Pit crew flow, everyone assigned No wasted motion, all aligned Compressions first, don’t break the chain Defib charged while compressions remain Airway’s set, 10 breaths per minute No hyperventilation, don’t get in it BIAD first, keep the pause low Tube comes second—don’t let it slow IV or IO, access fast But compressions are what will last Epi goes in, 1 milligram push No repeat routine—don’t rush, don’t mush (Pre-Chorus) Crystalloid bolus, half a liter run Up to two liters if the cause is one Reversible causes in the back of my mind But never before the compressions align (Chorus) Flatline life, but we don’t stop here Algorithms cutting through fear EtCO₂ watching every change If it spikes high, we rearrange ROSC can come like a sudden wave From the work that the compressions gave (Verse 3 – PEA Reality) Then it’s PEA—electric but dead Rhythm on paper, but no pulse ahead Hypoxia, hypovolemia, clot in the line Electrolytes off or a blocked design We search for causes, but never delay CPR is the price we always pay Glucose check, rule out the base Fix what we can while we keep the pace If they re-arrest, we go again Epi one time—back in the pen And if EtCO₂ climbs above the floor We know there might be something more (Bridge – System Mindset) Charge to 360, ready to go Before the next rhythm check show Minimize pause, keep it tight Compression is life in the darkest night EtCO₂ low, fix the press EtCO₂ high, reassess Goal is twenty, or we adjust In the algorithm, we trust Dump the shock—don’t waste that fight Asystole and PEA are never shockable in this fight No defib here, no shock to give We circulate what keeps them alive (Breakdown – Special Cases) Drowning, hypoxia, hanging tight Airway first in the fight Dialysis patients, different strain Electrolytes driving the pain Pregnant arrest, left uterine hand Defib still safe as we planned Every case a different scene Same foundation under the machine (Final Chorus) Flatline life, but we don’t quit Every second we commit Push hard, push fast, don’t let go In that rhythm we make hope grow If EtCO₂ rises, we see the sign Maybe this time we bring them back alive (Outro – Termination of Resuscitation) But tonight it doesn’t turn that way No ROSC in the end today Time runs out, the line stays flat We call it—no coming back Hands slow down, the room goes still After everything, it’s just that real Paperwork signed, monitor off light Another name carried into the night We pack the gear, close the door Same silence we’ve known before No victory here, no win to claim— Just another life that didn’t reclaim.
