Pulseless electrical activity (PEA) is lack of palpable pulse or cardiac contraction even with an organized cardiac electrical activity. Even though the heart is producing organized electrical activity, no mechanical activity is produced. There will be no contractions of the cardiac muscles. Any organized rhyme without a pulse is PEA (except VF, VT and asystole) and includes: idioventricular rhythms, ventricular escape rhythms, post-defibrillation idioventricular rhythms, and Bradyasystolic rhythms.
PEA can be caused by many factors and are represented as H’s and T’s:
|Hypovolemia – Decreased blood volume||Tension pneumothorax – air in the pleural space around the lung (lung collapses)|
|Hypoxia- decreased partial pressure of oxygen in blood||Tamponade – compression of the heart produced by excess fluid surrounding the heart|
|Hydrogen ion (acidosis) – Increase in the concentration of H ions in blood||Toxins – poisonous substances|
|Hyper-/hypokalemia –abnormally high or low potassium concentration in the blood||Thromobosis (pulmonary) – formation of a blood clot which blocks a blood vessel in lungs|
|Hypothermia – core temp is less than 96.8 F, and severe is less than 86 F||Thrombosis (coronary) –formation of a blood clot which blocks a blood vessel in heart|
Scenario: You are the physician on duty and are called to the ER to see a patient who was involved in a motorcycle accident and is now unresponsive.
The following is an algorithm shows management of cardiac arrest due to asystole/PEA (left side of chart)
To ensure the best outcome for PEA it is vital to have uninterrupted, high quality CPR and to quickly figure out the reversible causes.
You have completed Chapter VII. Now you should be able to:
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