Pulseless electrical activity physical examination: Difference between revisions
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== Overview == | == Overview == | ||
A rapid physical examination should be performed to identify rapidly reversible causes of PEA. Absence of palpable pulses is the main finding. Depending upon the cause of PEA, physical findings can be [[distended neck veins]], [[tracheal deviation]], unilateral absence of breath sounds, tachycardia, decreased skin turgor, traumatic chest, cool extremities, and cyanosis. | |||
==Physical Examination== | ==Physical Examination== | ||
A rapid physical examination should be performed to identify rapidly reversible causes of PEA: | A rapid physical examination should be performed to identify rapidly reversible causes of PEA: <ref name="pmid30020721">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume= | issue= | pages= | pmid=30020721 | doi= | pmc= | url= }}</ref> <ref name="pmid24297818">{{cite journal |vauthors=Myerburg RJ, Halperin H, Egan DA, Boineau R, Chugh SS, Gillis AM, Goldhaber JI, Lathrop DA, Liu P, Niemann JT, Ornato JP, Sopko G, Van Eyk JE, Walcott GP, Weisfeldt ML, Wright JD, Zipes DP |title=Pulseless electric activity: definition, causes, mechanisms, management, and research priorities for the next decade: report from a National Heart, Lung, and Blood Institute workshop |journal=Circulation |volume=128 |issue=23 |pages=2532–41 |date=December 2013 |pmid=24297818 |doi=10.1161/CIRCULATIONAHA.113.004490 |url=}}</ref><ref name="pmid22650157">{{cite journal |vauthors=Kalava A, Kalstein A, Koyfman S, Mardakh S, Yarmush JM, Schianodicola J |title=Pulseless electrical activity during electroconvulsive therapy: a case report |journal=BMC Anesthesiol |volume=12 |issue= |pages=8 |date=May 2012 |pmid=22650157 |pmc=3403950 |doi=10.1186/1471-2253-12-8 |url=}}</ref><ref name="pmid26472995">{{cite journal |vauthors=Link MS, Berkow LC, Kudenchuk PJ, Halperin HR, Hess EP, Moitra VK, Neumar RW, O'Neil BJ, Paxton JH, Silvers SM, White RD, Yannopoulos D, Donnino MW |title=Part 7: Adult Advanced Cardiovascular Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care |journal=Circulation |volume=132 |issue=18 Suppl 2 |pages=S444–64 |date=November 2015 |pmid=26472995 |doi=10.1161/CIR.0000000000000261 |url=}}</ref><ref name="pmid26477701">{{cite journal |vauthors=Soar J, Nolan JP, Böttiger BW, Perkins GD, Lott C, Carli P, Pellis T, Sandroni C, Skrifvars MB, Smith GB, Sunde K, Deakin CD |title=European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult advanced life support |journal=Resuscitation |volume=95 |issue= |pages=100–47 |date=October 2015 |pmid=26477701 |doi=10.1016/j.resuscitation.2015.07.016 |url=}}</ref><ref name="pmid20956224">{{cite journal |vauthors=Neumar RW, Otto CW, Link MS, Kronick SL, Shuster M, Callaway CW, Kudenchuk PJ, Ornato JP, McNally B, Silvers SM, Passman RS, White RD, Hess EP, Tang W, Davis D, Sinz E, Morrison LJ |title=Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care |journal=Circulation |volume=122 |issue=18 Suppl 3 |pages=S729–67 |date=November 2010 |pmid=20956224 |doi=10.1161/CIRCULATIONAHA.110.970988 |url=}}</ref> | ||
=== | |||
'''Pulse''' | |||
* Absence of palpable pulses is the main finding. | |||
Depending upon the cause, the following might be found: | |||
'''Neck''' | |||
*[[Distended neck veins]] suggests [[cardiac tamponade]] | *[[Distended neck veins]] suggests [[cardiac tamponade]] | ||
*[[Tracheal deviation]] suggests [[tension pneumothorax]] | *[[Tracheal deviation]] suggests [[tension pneumothorax]] | ||
'''Lungs''' | |||
*Unilateral absence of breath sounds suggests [[tension pneumothorax]] | *Unilateral absence of breath sounds suggests [[tension pneumothorax]] | ||
'''Heart''' | |||
*Tachycardia | |||
'''General''' | |||
* Decreased skin turgor | |||
* Traumatic chest | |||
* Cool extremities | |||
* Cyanosis | |||
===Appearance of the Patient=== | |||
*Patients with [disease name] usually appear [general appearance]. | |||
===Vital Signs=== | |||
*[[Hypothermia]] / hyperthermia may be present | |||
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse | |||
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse | |||
*Tachypnea / bradypnea | |||
*Absent pulse | |||
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]] | |||
===Skin=== | |||
* Skin examination of patients with pulseless electrical activity is usually normal. | |||
===HEENT=== | |||
* HEENT examination of patients with [disease name] is usually normal. | |||
OR | |||
* Abnormalities of the head/hair may include ___ | |||
* Evidence of trauma | |||
* Icteric sclera | |||
* [[Nystagmus]] | |||
* Extra-ocular movements may be abnormal | |||
*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation | |||
*Ophthalmoscopic exam may be abnormal with findings of ___ | |||
* Hearing acuity may be reduced | |||
*[[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".) | |||
*[[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".) | |||
* [[Exudate]] from the ear canal | |||
* Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal) | |||
*Inflamed nares / congested nares | |||
* [[Purulent]] exudate from the nares | |||
* Facial tenderness | |||
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae | |||
===Neck=== | |||
* Neck examination of patients with [disease name] is usually normal. | |||
OR | |||
*[[Jugular venous distension]] | |||
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope | |||
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry) | |||
*[[Thyromegaly]] / thyroid nodules | |||
*[[Hepatojugular reflux]] | |||
===Lungs=== | |||
* Pulmonary examination of patients pulseless electrical activity with is sometimes abnormal based on the cause. | |||
OR | |||
* Asymmetric chest expansion OR decreased chest expansion | |||
*Lungs are hyporesonant OR hyperresonant | |||
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally | |||
*Rhonchi | |||
*Normal/reduced [[tactile fremitus]] | |||
===Heart=== | |||
* Cardiovascular examination of patients with pulseless electrical activity is usually abnormal. | |||
*Chest tenderness upon palpation | |||
*[[Heave]] / [[thrill]] | |||
*[[Friction rub]] | |||
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]] | |||
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]] | |||
===Abdomen=== | |||
* Abdominal examination of patients with pulseless electrical activity is usually normal. | |||
===Back=== | |||
* Back examination of patients with pulseless electrical activity is usually normal. | |||
===Genitourinary=== | |||
* Genitourinary examination of patients with pulseless electrical activity is usually normal. | |||
===Neuromuscular=== | |||
* Neuromuscular examination of patients with pulseless electrical activity is usually normal. | |||
===Extremities=== | |||
* Extremities examination of patients with pulseless electrical activity is usually normal. | |||
* | |||
==References== | ==References== | ||
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[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Intensive care medicine]] | [[Category:Intensive care medicine]] | ||
[[Category: | [[Category:Medicine]] | ||
[[Category: | [[Category:Uptodate]] | ||
Latest revision as of 17:43, 27 April 2020
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Differentiating Pulseless Electrical Activity from other Diseases |
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Risk calculators and risk factors for Pulseless electrical activity physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
A rapid physical examination should be performed to identify rapidly reversible causes of PEA. Absence of palpable pulses is the main finding. Depending upon the cause of PEA, physical findings can be distended neck veins, tracheal deviation, unilateral absence of breath sounds, tachycardia, decreased skin turgor, traumatic chest, cool extremities, and cyanosis.
Physical Examination
A rapid physical examination should be performed to identify rapidly reversible causes of PEA: [1] [2][3][4][5][6]
Pulse
- Absence of palpable pulses is the main finding.
Depending upon the cause, the following might be found:
Neck
- Distended neck veins suggests cardiac tamponade
- Tracheal deviation suggests tension pneumothorax
Lungs
- Unilateral absence of breath sounds suggests tension pneumothorax
Heart
- Tachycardia
General
- Decreased skin turgor
- Traumatic chest
- Cool extremities
- Cyanosis
Appearance of the Patient
- Patients with [disease name] usually appear [general appearance].
Vital Signs
- Hypothermia / hyperthermia may be present
- Tachycardia with regular pulse or (ir)regularly irregular pulse
- Bradycardia with regular pulse or (ir)regularly irregular pulse
- Tachypnea / bradypnea
- Absent pulse
- High/low blood pressure with normal pulse pressure / wide pulse pressure / narrow pulse pressure
Skin
- Skin examination of patients with pulseless electrical activity is usually normal.
HEENT
- HEENT examination of patients with [disease name] is usually normal.
OR
- Abnormalities of the head/hair may include ___
- Evidence of trauma
- Icteric sclera
- Nystagmus
- Extra-ocular movements may be abnormal
- Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
- Ophthalmoscopic exam may be abnormal with findings of ___
- Hearing acuity may be reduced
- Weber test may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
- Rinne test may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
- Exudate from the ear canal
- Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
- Inflamed nares / congested nares
- Purulent exudate from the nares
- Facial tenderness
- Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae
Neck
- Neck examination of patients with [disease name] is usually normal.
OR
- Jugular venous distension
- Carotid bruits may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
- Lymphadenopathy (describe location, size, tenderness, mobility, and symmetry)
- Thyromegaly / thyroid nodules
- Hepatojugular reflux
Lungs
- Pulmonary examination of patients pulseless electrical activity with is sometimes abnormal based on the cause.
OR
- Asymmetric chest expansion OR decreased chest expansion
- Lungs are hyporesonant OR hyperresonant
- Fine/coarse crackles upon auscultation of the lung bases/apices unilaterally/bilaterally
- Rhonchi
- Normal/reduced tactile fremitus
Heart
- Cardiovascular examination of patients with pulseless electrical activity is usually abnormal.
- Chest tenderness upon palpation
- Heave / thrill
- Friction rub
- S1
- S2
Abdomen
- Abdominal examination of patients with pulseless electrical activity is usually normal.
Back
- Back examination of patients with pulseless electrical activity is usually normal.
Genitourinary
- Genitourinary examination of patients with pulseless electrical activity is usually normal.
Neuromuscular
- Neuromuscular examination of patients with pulseless electrical activity is usually normal.
Extremities
- Extremities examination of patients with pulseless electrical activity is usually normal.
References
- ↑ "StatPearls". 2020. PMID 30020721.
- ↑ Myerburg RJ, Halperin H, Egan DA, Boineau R, Chugh SS, Gillis AM, Goldhaber JI, Lathrop DA, Liu P, Niemann JT, Ornato JP, Sopko G, Van Eyk JE, Walcott GP, Weisfeldt ML, Wright JD, Zipes DP (December 2013). "Pulseless electric activity: definition, causes, mechanisms, management, and research priorities for the next decade: report from a National Heart, Lung, and Blood Institute workshop". Circulation. 128 (23): 2532–41. doi:10.1161/CIRCULATIONAHA.113.004490. PMID 24297818.
- ↑ Kalava A, Kalstein A, Koyfman S, Mardakh S, Yarmush JM, Schianodicola J (May 2012). "Pulseless electrical activity during electroconvulsive therapy: a case report". BMC Anesthesiol. 12: 8. doi:10.1186/1471-2253-12-8. PMC 3403950. PMID 22650157.
- ↑ Link MS, Berkow LC, Kudenchuk PJ, Halperin HR, Hess EP, Moitra VK, Neumar RW, O'Neil BJ, Paxton JH, Silvers SM, White RD, Yannopoulos D, Donnino MW (November 2015). "Part 7: Adult Advanced Cardiovascular Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 132 (18 Suppl 2): S444–64. doi:10.1161/CIR.0000000000000261. PMID 26472995.
- ↑ Soar J, Nolan JP, Böttiger BW, Perkins GD, Lott C, Carli P, Pellis T, Sandroni C, Skrifvars MB, Smith GB, Sunde K, Deakin CD (October 2015). "European Resuscitation Council Guidelines for Resuscitation 2015: Section 3. Adult advanced life support". Resuscitation. 95: 100–47. doi:10.1016/j.resuscitation.2015.07.016. PMID 26477701.
- ↑ Neumar RW, Otto CW, Link MS, Kronick SL, Shuster M, Callaway CW, Kudenchuk PJ, Ornato JP, McNally B, Silvers SM, Passman RS, White RD, Hess EP, Tang W, Davis D, Sinz E, Morrison LJ (November 2010). "Part 8: adult advanced cardiovascular life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 122 (18 Suppl 3): S729–67. doi:10.1161/CIRCULATIONAHA.110.970988. PMID 20956224.