Pulseless electrical activity (PEA) occurs when a major cardiovascular, respiratory, or metabolic derangement results in the inability of cardiac muscle to generate sufficient force in response to electrical depolarization.
What are the 2 most common causes of pulseless electrical activity?
Hypovolemia and hypoxia are the two most common causes of PEA. They are also the most easily reversible and should be at the top of any differential diagnosis.
Why do we not shock PEA?
Pulseless electrical activity (PEA) refers to cardiac arrest in which the electrocardiogram shows a heart rhythm that should produce a pulse, but does not. Pulseless electrical activity is found initially in about 55% of people in cardiac arrest.
|Pulseless electrical activity|
How do you identify pulseless electrical activity?
Pseudo-PEA can be detected in the absence of a palpable pulse by:
- arterial line placement during cardiac arrest (identified by the presence of a blood pressure)
- high ETCO2 readings in intubated patients.
- echocardiography or Doppler ultrasound demonstrating cardiac pulsatility.
Which is are possible underlying cause s of Asystolic rhythms?
Asystole is caused by a glitch in your heart’s electrical system. You can get a ventricular arrhythmia when the signals are off. That’s when your lower chambers don’t beat the right way. So your heart can’t pump blood to the rest of your body.
Why does PEA happen?
PEA is always caused by a profound cardiovascular insult (eg, severe prolonged hypoxia or acidosis or extreme hypovolemia or flow-restricting pulmonary embolus). The initial insult weakens cardiac contraction, and this situation is exacerbated by worsening acidosis, hypoxia, and increasing vagal tone.
Can PEA look like NSR?
Pulseless Electrical Activity (PEA) Diagnosis
An electrocardiogram (ECG/EKG) device is capable of distinguishing PEA from other causes of cardiac arrest. The ECG interpretation can appear the same as a normal sinus rhythm.
Is PEA a shockable rhythm?
Rhythms that are not amenable to shock include pulseless electrical activity (PEA) and asystole. In these cases, identifying primary causation, performing good CPR, and administering epinephrine are the only tools you have to resuscitate the patient.
What causes pulseless ventricular tachycardia?
Pulseless ventricular tachycardia (VT) can result from a multitude of causes and predisposing conditions, including but not limited to, structural heart disease, electrolyte disturbances, drugs/medications, and congenital/inherited channelopathies.
Is PEA The first monitored rhythm?
The first monitored rhythm is VF/pVT in approximately 20% of cardiac arrests, both in-hospital or out-of-hospital. VF/pVT will also occur at some stage during resuscitation in about 25% of cardiac arrests with an initial documented rhythm of asystole or PEA.
Which drug is given first to a patient with pulseless electrical activity?
Epinephrine should be administered in 1-mg doses intravenously/intraosseously (IV/IO) every 3-5 minutes during pulseless electrical activity (PEA) arrest. Higher doses of epinephrine have been studied and show no improvement in survival or neurologic outcomes in most patients.
Why is asystole not shockable?
Pulseless electrical activity and asystole or flatlining (3 and 4), in contrast, are non-shockable, so they don’t respond to defibrillation. These rhythms indicate that the heart muscle itself is dysfunctional; it has stopped listening to the orders to contract.
How is pulseless electrical activity treated?
Treatment / Management
The first step in managing pulseless electrical activity is to begin chest compressions according to the advanced cardiac life support (ACLS) protocol followed by administrating epinephrine every 3 to 5 minutes, while simultaneously looking for any reversible causes.
How is transcutaneous pacing done?
Transcutaneous pacing is accomplished by delivering pulses of electric current through the patient’s chest, which stimulates the heart to contract. The most common indication for transcutaneous pacing is an abnormally slow heart rate.
What is the difference between asystole and pea?
Know the Difference Between PEA and Asystole
Asystole is the flatline reading where all electrical activity within the heart ceases. PEA, on the other hand, may include randomized, fibrillation-like activity, but it does not rise to the level of actual fibrillation.