Pulseless electrical activity (patient information): Difference between revisions
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==What are the symptoms of Pulseless electrical activity?== | ==What are the symptoms of Pulseless electrical activity?== | ||
Absence of palpable [[pulses]] is the main finding. | Absence of palpable [[pulses]] is the main finding. | ||
Depending upon the cause, the following might be found: | Depending upon the cause, the following might be found: | ||
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* Decreased [[skin]] turgor | * Decreased [[skin]] turgor | ||
* Traumatic [[chest]] | * Traumatic [[chest]] | ||
* Cool [[extremities]] | |||
* [[Tachycardia]] | |||
* [[Cyanosis]] | |||
==What causes Pulseless electrical activity?== | ==What causes Pulseless electrical activity?== | ||
Common causes of PEA include preceding [[respiratory failure]] in 40% to 50% of cases, and [[hypovolemia]]. | |||
The common causes of PEA can be remembered using the mnemonic "The Hs and Ts". | |||
* [[Hypovolemia|'''H'''ypovolemia]] | |||
* [[Hypoxia|'''H'''ypoxia]] | |||
* [[Hydrogen|'''H'''ydrogen]] ions ([[Acidosis]]) | |||
* [[Hypothermia|'''H'''ypothermia]] | |||
* [[Hyperkalemia|'''H'''yperkalemia]] or [[Hypokalemia|'''H'''ypokalemia]] | |||
* [[Hypoglycemia|'''H'''ypoglycemia]] | |||
* [[Tablets|'''T'''ablets]] or [[Toxins|'''T'''oxins]] ([[Drug overdose]]) such as [[beta blocker]]s, [[tricyclic antidepressant]]s, or [[calcium channel blockers]] | |||
* [[Cardiac tamponade|'''T'''amponade]] | |||
* [[Tension pneumothorax|'''T'''ension pneumothorax]] | |||
* [[Thrombosis|'''T'''hrombosis]] ([[Myocardial infarction]]) | |||
* [[Thrombosis|'''T'''hrombosis]] ([[Pulmonary embolism]]) | |||
* [[Physical trauma|'''T'''rauma]] ([[Hypovolemia]] from [[blood loss]]) | |||
*[[Covid-19]] | |||
==Who is at highest risk?== | ==Who is at highest risk?== | ||
* [[Age]] i.e elderly | |||
* Black race | |||
* Female gender | |||
* [[Heart failure]] patients | |||
* [[Pulmonary disease]] | |||
* [[Syncope]] | |||
==Diagnosis== | ==Diagnosis== | ||
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==Treatment options== | ==Treatment options== | ||
The current American Heart Association-Advanced Cardiac Life Support (AHA-ACLS) guidelines advise the following be undertaken in all patients: | |||
*Start CPR immediately | |||
*Administer 100% oxygen to reverse [[hypoxia]] | |||
*[[Intubate]] the patient | |||
*Establish IV access | |||
The mainstay of drug therapy for PEA is [[epinephrine]] 1mg every 3–5 minutes. Higher doses of epinephrine can be administered in patients with suspected [[beta blocker]] and [[calcium channel blocker]] overdose. Otherwise high dose epinephrine has not demonstrated a benefit in survival or neurologic recovery. | |||
==Where to find medical care for Pulseless electrical activity?== | ==Where to find medical care for Pulseless electrical activity?== | ||
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==Prevention== | ==Prevention== | ||
There are no established preventive measures for pulseless electrical activity. | |||
==What to expect (Outlook/Prognosis)?== | ==What to expect (Outlook/Prognosis)?== | ||
The overall [[prognosis]] is poor for pulseless electrical activity unless any reversible [[causes]] exists. Also the more abnormal the [[Ecg]] findings on intial admission the more worse the [[prognosis]].The time to intiate [[CPR]] also plays a pivotal role in [[prognosis]]. Persons who got [[CPR]] by a layperson or bystander and immediate defibrillation are noted to have better outcome after out-of-hospital [[udden cardiac arrest]](SCA). | |||
==Possible complications== | ==Possible complications== | ||
The following [[complications]] are mostly seen in pulseless electrical activity: | |||
* [[Rib fractures]] due to repeated chest compressions during [[CPR]] | |||
* Poor [[perfusion]] can lead to [[Ischemia]] of [[extremities]] | |||
* [[Anoxic]] [[brain]] injury | |||
==Sources== | ==Sources== | ||
Latest revision as of 17:59, 10 June 2020
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Resident Survival Guide |
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Pulseless electrical activity |
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Where to find medical care for Pulseless electrical activity? |
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Pulseless electrical activity On the Web |
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Directions to Hospitals Treating Pulseless electrical activity |
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Risk calculators and risk factors for Pulseless electrical activity |
For the WikiDoc page for this topic, click here
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief:; Assistant Editor(s)-In-Chief:
Overview
What are the symptoms of Pulseless electrical activity?
Absence of palpable pulses is the main finding. Depending upon the cause, the following might be found:
- Tracheal deviation in or the unilateral absence of breath sounds in tension pneumothorax
- Decreased skin turgor
- Traumatic chest
- Cool extremities
- Tachycardia
- Cyanosis
What causes Pulseless electrical activity?
Common causes of PEA include preceding respiratory failure in 40% to 50% of cases, and hypovolemia. The common causes of PEA can be remembered using the mnemonic "The Hs and Ts".
- Hypovolemia
- Hypoxia
- Hydrogen ions (Acidosis)
- Hypothermia
- Hyperkalemia or Hypokalemia
- Hypoglycemia
- Tablets or Toxins (Drug overdose) such as beta blockers, tricyclic antidepressants, or calcium channel blockers
- Tamponade
- Tension pneumothorax
- Thrombosis (Myocardial infarction)
- Thrombosis (Pulmonary embolism)
- Trauma (Hypovolemia from blood loss)
- Covid-19
Who is at highest risk?
- Age i.e elderly
- Black race
- Female gender
- Heart failure patients
- Pulmonary disease
- Syncope
Diagnosis
When to seek urgent medical care?
Treatment options
The current American Heart Association-Advanced Cardiac Life Support (AHA-ACLS) guidelines advise the following be undertaken in all patients:
- Start CPR immediately
- Administer 100% oxygen to reverse hypoxia
- Intubate the patient
- Establish IV access
The mainstay of drug therapy for PEA is epinephrine 1mg every 3–5 minutes. Higher doses of epinephrine can be administered in patients with suspected beta blocker and calcium channel blocker overdose. Otherwise high dose epinephrine has not demonstrated a benefit in survival or neurologic recovery.
Where to find medical care for Pulseless electrical activity?
Directions to Hospitals Treating Condition
Prevention
There are no established preventive measures for pulseless electrical activity.
What to expect (Outlook/Prognosis)?
The overall prognosis is poor for pulseless electrical activity unless any reversible causes exists. Also the more abnormal the Ecg findings on intial admission the more worse the prognosis.The time to intiate CPR also plays a pivotal role in prognosis. Persons who got CPR by a layperson or bystander and immediate defibrillation are noted to have better outcome after out-of-hospital udden cardiac arrest(SCA).
Possible complications
The following complications are mostly seen in pulseless electrical activity:
- Rib fractures due to repeated chest compressions during CPR
- Poor perfusion can lead to Ischemia of extremities
- Anoxic brain injury