Pulseless electrical activity electrocardiogram: Difference between revisions
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==Electrocardiogram== | ==Electrocardiogram== | ||
The appearance of the [[electrocardiogram]] in the setting of PEA varies, but several common patterns exist. There may be a normal [[sinus rhythm]] or [[sinus tachycardia]], with discernible [[P waves]] and [[QRS complexes]]. Sometimes there is a [[bradycardia]], with or without [[P waves]], and often there is a [[wide QRS complex]]. The presence of a [[QRS interval]] > 0.20 seconds is associated with a poorer prognosis. The EKG should be carefully evaluated for signs of:<ref name="pmid20970286">{{cite journal| author=Mehta C, Brady W| title=Pulseless electrical activity in cardiac arrest: electrocardiographic presentations and management considerations based on the electrocardiogram. | journal=Am J Emerg Med | year= 2012 | volume= 30 | issue= 1 | pages= 236-9 | pmid=20970286 | doi=10.1016/j.ajem.2010.08.017 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20970286 }}</ref><ref name="pmid30538976">{{cite journal |vauthors=Luong DH, Cheung PY, O'Reilly M, Lee TF, Schmolzer GM |title=Electrocardiography vs. Auscultation to Assess Heart Rate During Cardiac Arrest With Pulseless Electrical Activity in Newborn Infants |journal=Front Pediatr |volume=6 |issue= |pages=366 |date=2018 |pmid=30538976 |pmc=6277703 |doi=10.3389/fped.2018.00366 |url=}}</ref><ref name=":0">Foster B, Twelve Lead Electrocardiography, 2nd edition, 2007</ref><ref name="pmid31151388">{{cite journal |vauthors=Varga C, Kálmán Z, Szakáll A, Drubits K, Koch M, Bánhegyi R, Oláh T, Pozsgai É, Fülöp N, Betlehem J |title=ECG alterations suggestive of hyperkalemia in normokalemic versus hyperkalemic patients |journal=BMC Emerg Med |volume=19 |issue=1 |pages=33 |date=May 2019 |pmid=31151388 |pmc=6814982 |doi=10.1186/s12873-019-0247-0 |url=}}</ref> | The appearance of the [[electrocardiogram]] in the setting of PEA varies, but several common patterns exist. There may be a normal [[sinus rhythm]] or [[sinus tachycardia]], with discernible [[P waves]] and [[QRS complexes]]. Sometimes there is a [[bradycardia]], with or without [[P waves]], and often there is a [[wide QRS complex]]. The presence of a [[QRS interval]] > 0.20 seconds is associated with a poorer prognosis. The EKG should be carefully evaluated for signs of:<ref name="pmid20970286">{{cite journal| author=Mehta C, Brady W| title=Pulseless electrical activity in cardiac arrest: electrocardiographic presentations and management considerations based on the electrocardiogram. | journal=Am J Emerg Med | year= 2012 | volume= 30 | issue= 1 | pages= 236-9 | pmid=20970286 | doi=10.1016/j.ajem.2010.08.017 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20970286 }}</ref><ref name="pmid30538976">{{cite journal |vauthors=Luong DH, Cheung PY, O'Reilly M, Lee TF, Schmolzer GM |title=Electrocardiography vs. Auscultation to Assess Heart Rate During Cardiac Arrest With Pulseless Electrical Activity in Newborn Infants |journal=Front Pediatr |volume=6 |issue= |pages=366 |date=2018 |pmid=30538976 |pmc=6277703 |doi=10.3389/fped.2018.00366 |url=}}</ref><ref name=":0">Foster B, Twelve Lead Electrocardiography, 2nd edition, 2007</ref><ref name="pmid31151388">{{cite journal |vauthors=Varga C, Kálmán Z, Szakáll A, Drubits K, Koch M, Bánhegyi R, Oláh T, Pozsgai É, Fülöp N, Betlehem J |title=ECG alterations suggestive of hyperkalemia in normokalemic versus hyperkalemic patients |journal=BMC Emerg Med |volume=19 |issue=1 |pages=33 |date=May 2019 |pmid=31151388 |pmc=6814982 |doi=10.1186/s12873-019-0247-0 |url=}}</ref><ref name="pmid30697500">{{cite journal |vauthors=Atkinson PR, Keyes AW, O'Donnell K, Beckett N, Banerjee A, Fraser J, Lewis D |title=Do Electrocardiogram Rhythm Findings Predict Cardiac Activity During a Cardiac Arrest? A Study from the Sonography in Cardiac Arrest and Hypotension in the Emergency Department (SHoC-ED) Investigators |journal=Cureus |volume=10 |issue=11 |pages=e3624 |date=November 2018 |pmid=30697500 |pmc=6347444 |doi=10.7759/cureus.3624 |url=}}</ref> | ||
*[[Hyperkalemia]] (peaked [[T waves]], [[complete heart block]], a ventricular escape rhythm) | *[[Hyperkalemia]] (peaked [[T waves]], [[complete heart block]], a ventricular escape rhythm) | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The appearance of the electrocardiogram in the setting of PEA varies, but several common patterns exist. There may be a normal sinus rhythm or sinus tachycardia, with discernible P waves and QRS complexes. Sometimes there is a bradycardia, with or without P waves, and often there is a wide QRS complex.[1] The presence of a QRS interval > 0.20 seconds is associated with a poorer prognosis. The EKG should be carefully evaluated for signs of Hyperkalemia, ST segment elevation MI, hypothermia, QRS interval prolongation suggests tricyclic antidepressant overdose
Electrocardiogram
The appearance of the electrocardiogram in the setting of PEA varies, but several common patterns exist. There may be a normal sinus rhythm or sinus tachycardia, with discernible P waves and QRS complexes. Sometimes there is a bradycardia, with or without P waves, and often there is a wide QRS complex. The presence of a QRS interval > 0.20 seconds is associated with a poorer prognosis. The EKG should be carefully evaluated for signs of:[2][3][1][4][5]
- Hyperkalemia (peaked T waves, complete heart block, a ventricular escape rhythm)
- ST segment elevation MI should be ruled out
- Osborne waves suggest hypothermia
- QRS interval prolongation suggests tricyclic antidepressant overdose
References
- ↑ 1.0 1.1 Foster B, Twelve Lead Electrocardiography, 2nd edition, 2007
- ↑ Mehta C, Brady W (2012). "Pulseless electrical activity in cardiac arrest: electrocardiographic presentations and management considerations based on the electrocardiogram". Am J Emerg Med. 30 (1): 236–9. doi:10.1016/j.ajem.2010.08.017. PMID 20970286.
- ↑ Luong DH, Cheung PY, O'Reilly M, Lee TF, Schmolzer GM (2018). "Electrocardiography vs. Auscultation to Assess Heart Rate During Cardiac Arrest With Pulseless Electrical Activity in Newborn Infants". Front Pediatr. 6: 366. doi:10.3389/fped.2018.00366. PMC 6277703. PMID 30538976.
- ↑ Varga C, Kálmán Z, Szakáll A, Drubits K, Koch M, Bánhegyi R, Oláh T, Pozsgai É, Fülöp N, Betlehem J (May 2019). "ECG alterations suggestive of hyperkalemia in normokalemic versus hyperkalemic patients". BMC Emerg Med. 19 (1): 33. doi:10.1186/s12873-019-0247-0. PMC 6814982 Check
|pmc=value (help). PMID 31151388. - ↑ Atkinson PR, Keyes AW, O'Donnell K, Beckett N, Banerjee A, Fraser J, Lewis D (November 2018). "Do Electrocardiogram Rhythm Findings Predict Cardiac Activity During a Cardiac Arrest? A Study from the Sonography in Cardiac Arrest and Hypotension in the Emergency Department (SHoC-ED) Investigators". Cureus. 10 (11): e3624. doi:10.7759/cureus.3624. PMC 6347444. PMID 30697500.