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Rethinking "PEA"

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by

Juliana Tolles

on 13 July 2015

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Transcript of Rethinking "PEA"

PITFALL #1:
M&M
Juliana Tolles
01.29.2015
Epinephrine
Vasopressin 40 U
Management Refractory VF
In the hospital the decision to terminate
resuscitative efforts rests with the treating physician.
-AHA guidelines
25M
Witnessed Arrest
Paramedic Arrival:
VF
2 defibrillations
amiodarone 450mg
epinephrine 2mg
advanced airway
10 min
ED arrival
VF
CPR
20 min
defibrillation
epinephrine 1mg
lidocaine 100 mg
ROSC

PEA
Narrow
Complex
~ 80 bpm
vasopressin 40U
IV Fluids
Ca 3g
Norepi
10mcg/min
Mag 2g
ABG
7.40
37
250
Dobutamine
10mcg/kg/min
Palpable pulses
(sustained)
amiodarone
1mg/min
Amiodarone

Lidocaine

Procainamide

Magnesium

Beta Blockers
Post-arrest Myocardial Dysfunction
PEA
Cellular metabolism

Circulation
Ventilation
Preload or Outflow
Fluids
Pressors
Lysis PRN
Metabolic or Ischemic
Hyper K+
Tox
Inotropes
10 min
Bedside TTE:
Cardiac motion
Dobutamine 5-10 mcg/kg
Intra-aortic balloon pump
Refractory VF
PITFALL #2:
Epi in PEA
PITFALL #3:
"PEA"
PITFALL #4:
RELYING ON PULSES
TO ASSESS ROSC
Take-home points
PITFALL #5:
Resuscitation Termination
Refractory VF: Amio, Lido, Mg, BB
Consider limiting your epi (use vaso)
Narrow complex PEA = different beast
End-tidal CO2 for "pulseless ROSC"
End-Tidal CO2
ECMO
Full transcript