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.
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.
What can cause pulseless electrical activity?
Various causes of pulseless electrical activity include significant hypoxia, profound acidosis, severe hypovolemia, tension pneumothorax, electrolyte imbalance, drug overdose, sepsis, large myocardial infarction, massive pulmonary embolism, cardiac tamponade, hypoglycemia, hypothermia, and trauma.
Is pulseless electrical activity shockable?
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.
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.
How does hypovolemia cause PEA?
Volume loss resulting in PEA is most likely to occur in cases of major trauma. In these situations, rapid blood loss and subsequent hypovolemia can exhaust cardiovascular compensatory mechanisms, culminating in PEA. Cardiac tamponade may also cause decreased ventricular filling.
Is PEA and asystole shockable?
Both PEA and asystole remain non shockable rhythms. With that in mind, treating the causes of arrest should lead to a period where the rhythm enters a shockable state.
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.
Can a person breathe without a pulse?
Without blood, the brain cannot survive. A constant supply of fresh blood is required to keep the brain alive and functioning properly. When blood supply stops, the brain shuts down, including its respiratory center. So, when the heart stops, so does breathing, usually within a minute or less.
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.
Can you do CPR on asystole?
Asystole is treated by cardiopulmonary resuscitation (CPR) combined with an intravenous vasopressor such as epinephrine (a.k.a. adrenaline). Sometimes an underlying reversible cause can be detected and treated (the so-called “Hs and Ts”, an example of which is hypokalaemia).
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.
What drugs are used in PEA?
Inotropic, anticholinergic, and alkalinizing agents are used in the treatment of pulseless electrical activity (PEA). As previously stated, resuscitative pharmacology includes epinephrine and atropine.
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.