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Pulseless Electrical Activity

How to recgonize rhythm?

With PEA, electrical activity is present on the ECG but mechanical activity of the ventricles is not present.

  • This is the most common dysrhythmia observed after defibrilation

Brooke Bollock

Naomi Brooks

MJ Koch

Alyssa Vela

Signs/Symptoms

Risks and Causes of PEA

Interventions/Complications

1. Pulseless: patient has no viable pulse

2. Apneic: suspension of breathing/absence of respirations

3. Electrical activity on ECG: Even though electrical activity can be observed; no mechanical actvity of ventricles is evident

4. No heart tones on ascultation: becase of no cardiac electrical activity, contractions of the myocardium and no cardiac output or blood flow

5. Unresponsive: patient is unreactive, unresponse, apathetic and emotionless

Once PEA is suspected:

  • Initiate CPR
  • Place an intravenous line
  • Intubate the patient
  • Correct hypoxia by administering 100% oxygen
  • Initiation of ACLS measures
  • Drug therapy

The H's and T's Causes

Risks

  • Toxins
  • Tamponade (cardiac)
  • Thrombosis (MI and pulmonary)
  • Tension pneumothorax
  • Trauma

  • Hypovolemia
  • Hypoxia
  • Hydrogen ion (acidosis)
  • Hyper-/hypokalemia
  • Hypoglycemia
  • Hypothermia

The biggest risk of PEA is death. Revealed in a recent study, only 11.2% of patients who had PEA as their first documented rhythm survived to hospital discharge.

Complications can arise from any of the aggressive life saving procedures done for PEA

Thank You!

Medications

Vasopressin-pituitary hormone

Promotes reabsorption of water via action on the renal tubular epithelium, causes vasoconstriction

Given subq, IM, IO, and IV

May replace either first or second dose of epinephrine

Epinephrine- bronchodilator nonselective adrenergic agonist, vasopressor

Causes bronchodilation, cardiac and CNS stimulation

Give subq, IM, intraosseously (IO) and IV

Epinephrine should be given in 1mg doses IV/IO every 3-5 min during PEA arrest

Atropine-antidysrhythmic, anticholinergic, parasympatholytic, antimuscarinic

Blocks acetylcholine at parasympathetic neuroeffector sites; increases cardiac output, HR by blocking vagal stimulaton in the heart

Give Subq, IM, PO, and IV

Administer if underlying cause of PEA is hypotension

What is Pulseless Electrical Activity?

It means exactly as it sounds, electrical activity without a palpable pulse.

ECG

62

bpm

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