How do you identify a pulseless electrical activity on an ECG?
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.
What do you do in pulseless electrical activity?
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 is the most common cause of pulseless electrical activity?
Hypoxia secondary to respiratory failure is probably the most common cause of PEA, with respiratory insufficiency accompanying 40-50% of PEA cases.
How do you know if a patient is in PEA?
Signs and Symptoms. A patient with PEA will be unconscious with no breathing and no pulse. PEA leads to a loss of cardiac output and discontinues blood supply to the brain. The skin may appear pallor due to no oxygen in the blood.
Does PEA look like sinus rhythm?
PEA is one of many waveforms by ECG (including sinus rhythm) without a detectable pulse. PEA may include any pulseless waveform with the exception of VF, VT, or asystole (Figure 28). Hypovolemia and hypoxia are the two most common causes of PEA.
What is a PEA rhythm?
True PEA is a condition in which cardiac contractions are absent in the presence of coordinated electrical activity. PEA encompasses a number of organized cardiac rhythms, including supraventricular rhythms (sinus versus nonsinus) and ventricular rhythms (accelerated idioventricular or escape).
What are shockable rhythms in the pulseless patient?
The two shockable rhythms are ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT) while the non–shockable rhythms include sinus rhythm (SR), supraventricular tachycardia (SVT), premature ventricualr contraction (PVC), atrial fibrilation (AF) and so on.
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.
What are the pulseless rhythms?
All cardiac arrest rhythms—that is, pulseless rhythms—that fall outside the category of pulseless ventricular tachycardia, ventricular fibrillation, or asystole are considered pulseless electrical activity.
What is the difference between pulseless VT and PEA?
PEA is one of many waveforms by ECG (including sinus rhythm) without a detectable pulse. PEA may include any pulseless waveform with the exception of VF, VT, or asystole (Figure 28)….Rules for Asystole and PEA.
| PEA Regularity | Any rhythm including a flat line (asystole). |
|---|---|
| QRS | Possible QRS complex or none detectable. |
Do you defibrillate PEA?
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.