Pulseless Electrical Activity
PEA Pathway of the Cardiac Arrest Algorithm
1. Emergency Response Team/AED to bedside/START CPR immediately 2. Shockable Rhtym? stop CPR for 10 secs or less for rhythm and pulse checks. Resume chest compressions immediately. Not a shockable rhythm --> PEA 3. CPR 2 min: establis IV/IO access, give Epinephrine 1 mg q 3-5 minutes, consider advanced airway 4. Rhythm shockable, yes (go to VF/VT pathway), no (continue CPR)
5 Hs
1. Hypovolemia - narrow complex, rapid rate. Hx of flat neck veins. Tx with volume infusion 2. Hypoxia - Slow rate (hypoxia), Cyanosis, blood gases, airway problems. Tx with oxygenation, ventilation advanced airway. 3. Hydrogen ion (acidosis) - Smaller-amplitude QRS complex. Hx of diabetes, renal failure. Tx ventilation, sodium bicarbonate. 4. Hyperkalemia - ECG: T waves taller and peakced, P waves get smaller, QRS widens, Sine wave PEA. Hx of renal failure, diabetes, recent dialysis, dialysis fistuals, medications Tx. Calcium chloride, sodium bicar, glucose plus insulin, possibly albuterol Hypokalemia - ECG: T waves flatten, Prominent U waves, QRS widens, QT prolongs, wide-complex tachycardia. hx of diuretic use. Tx: Add magneisum if cardiac arrest 5. Hypothermia: J or Osborne waves. Hx of exposure to cold, central body temperature. Rewarm according to local protocol.
5 Ts
1. Tension Pneumothorax: Narrow complex, slow rate (hypoxia). Hx.: pulse felt with CPR, neck vein distension, trahceal deviation, unequal breath sounds, difficult to ventilate pt. tx. needle decompression, tube toracostomy 2. Tamponade cardiac: narrow complex, rapid rate. Hx, no pulse felt with CPR, vein distention. Pericardiocentesis 3. Toxins (drug overdose): 4. Thrombosis, lungs: massive PE: narrow complex, rapid rate. Hx, no pulse felt with CPR, distended neck veins, prior positive DVT. Surgical embolectomy. Fibrinolytics 5. Thrombosis, heart: acute, massive MI: abnormal ECG: Q waves --> ST-segment changes --> T waves, inversions.
IV/IO access or advanced airway? Priority?
IV/IO over airway unless bag mask ventilation inadequate and arrest due to hypoxia
PEA encompasses what?
a group of rhythms that are organized or semiorganized, but lack a palpable pulse, this includes: --idioventricular rhythms --ventricular escape rhythms --postdefibrillation idioventricular rhythms --sinus rhythm Any organized rhythm wihout a pulse is defined as PEA. Pulseless rhtyhms that are excluded by definition include VF, VT, and asystole.
PEA also includes what?
conditions where the hart is empty b/c of inadequate preload. In this case, the contractile function of the heart is adequate, but there is inadequate volume for the ventricle to eject --hypovolemia --decreased venous return from pulmonary embolism of pneumothorax.
what are the 2 most common causes and easily reversible causes of PEA
hypovolemia hypoxia
