Pulseless electrical activity: Difference between revisions
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{{SK}} PEA; electromechanical dissociation; non-perfusing rhythm | |||
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==Overview== | ==Overview== | ||
Pulseless electrical activity refers to any heart rhythm observed on the [[electrocardiogram]] that should be producing a [[pulse]], but is not. The condition may or may not be caused by electromechanical dissociation. The most common cause is [[hypovolemia]]. | |||
The normal condition when electrical activation of muscle cells precedes mechanical contraction is known as '''Electromechanical Coupling'''. | The normal condition when electrical activation of muscle cells precedes mechanical contraction is known as '''Electromechanical Coupling'''. | ||
Revision as of 05:28, 16 September 2012
| Pulseless electrical activity |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: PEA; electromechanical dissociation; non-perfusing rhythm
Overview
Pulseless electrical activity refers to any heart rhythm observed on the electrocardiogram that should be producing a pulse, but is not. The condition may or may not be caused by electromechanical dissociation. The most common cause is hypovolemia.
The normal condition when electrical activation of muscle cells precedes mechanical contraction is known as Electromechanical Coupling.
The goal of treatment of PEA is to treat the underlying cause. These possible causes are remembered as the Hs and Ts.[1][2][3]
- Hypovolemia
- Hypoxia
- Hydrogen ions (Acidosis)
- Hypothermia
- Hyperkalemia or Hypokalemia
- Hypoglycemia
- Tablets or Toxins (Drug overdose)
- Cardiac Tamponade
- Tension pneumothorax
- Thrombosis (Myocardial infarction)
- Thrombosis (Pulmonary embolism)
- Trauma (Hypovolemia from blood loss)
In those cases in which an underlying systemic cause is unable to be immediately identified, the patient should be treated as if they were in asystole: intravenous Epinephrine 1 mg every 3-5 minutes, and, if the underlying rhythm is bradycardia, Atropine 1 mg IV up to .04 mg/kg (varies with regional protocols). Both these drugs should be administered along with appropriate CPR techniques. Defibrillationis not used for this rhythm, as the problem lies in the response of the myocardial tissue to electrical impulses.
Pulseless Electrical Activity
In pulseless electrical activity the heart continues to work electrically but fails to provide a cardiac output sufficient to produce a palpable pulse.
Electrocardiographic features of pulseless electrical activity
The appearance of the electrocardiogram 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 with wide QRS complexes.[4]
Successful treatment of pulseless electrical activity depends on whether it is a primary cardiac event or is secondary to a potentially reversible disorder.
Potentially reversible causes of pulseless electrical activity
- Hypovolemia
- Cardiac tamponade
- Tension pneumothorax
- Massive pulmonary embolism
- Hyperkalemia, hypokalemia, and metabolic disorders
- Hypothermia
- Toxic disturbances as overdoses of beta blockers, tricyclic antidepressants, or calcium channel blockers.
References
- ↑ ACLS: Principles and Practice. p. 71-87. Dallas: American Heart Association, 2003. ISBN 0-87493-341-2.
- ↑ ACLS for Experienced Providers. p. 3-5. Dallas: American Heart Association, 2003. ISBN 0-87493-424-9.
- ↑ "2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care - Part 7.2: Management of Cardiac Arrest." Circulation 2005; 112: IV-58 - IV-66.
- ↑ Foster B, Twelve Lead Electrocardiography, 2nd edition, 2007