Pulseless electrical activity resident survival guide: Difference between revisions

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===Common Causes===
===Common Causes===
The complete list of causes of PEA can be remembered using the mnemonic "The Hs and Ts".<ref name=ACLS_2003_H_T>''ACLS: Principles and Practice''. p. 71-87. Dallas: American Heart Association, 2003. ISBN 0-87493-341-2.</ref><ref name=ACLS_2003_EP_HT>''ACLS for Experienced Providers''. p. 3-5. Dallas: American Heart Association, 2003. ISBN 0-87493-424-9.</ref><ref name="ECC_2005_7.2">"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.</ref>


==Management==
==Management==

Revision as of 14:55, 11 September 2013

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahmoud Sakr, M.D. [2]

Definition

Pulseless electrical activity is defined as the absence of a pulse or cardiac contractility despite the presence of electrocardiographic activity. The most common causes are respiratory failure and hypovolemia.

Causes

Life Threatening Causes

Common Causes

The complete list of causes of PEA can be remembered using the mnemonic "The Hs and Ts".[1][2][3]

Management

Below is an algorithm summarizing the approach to a patient with pulseless electrical activity. Based on the 2010 American heart association ACLS algorithm for PEA[4]







Do's

  • Efficiency of CPR can be determined by
    • Monitoring of chest compression rate and depth
    • Adequacy of chest wall relaxation
    • Length and duration of pauses in compression and number and depth of ventilations delivered
    • Physiologic parameters; partial pressure of end-tidal CO2 [PETCO2], arterial pressure during the relaxation phase of chest compressions, central venous oxygen saturation [ScvO2]
  • Remember that the foundation of successful ACLS is good BLS , represented in prompt high-quality CPR with minimal interruptions.[5][6]
  • A new class I recommendation is the use of quantitative waveform capnography for confirmation and monitoring of endotracheal tube placement.
  • Supraglottic advanced airways continues to be an alternative to endotracheal intubation for airway management during CPR.

Don'ts

  • Don't routinely use cricoid pressure during airway management of patients in cardiac arrest.
  • Don't routinely administer atropine in the management of pulseless asystole.

References

  1. ↑ ACLS: Principles and Practice. p. 71-87. Dallas: American Heart Association, 2003. ISBN 0-87493-341-2.
  2. ↑ ACLS for Experienced Providers. p. 3-5. Dallas: American Heart Association, 2003. ISBN 0-87493-424-9.
  3. ↑ "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.
  4. ↑ Field JM, Hazinski MF, Sayre MR, Chameides L, Schexnayder SM, Hemphill R; et al. (2010). "Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 122 (18 Suppl 3): S640–56. doi:10.1161/CIRCULATIONAHA.110.970889. PMID 20956217.
  5. ↑ Edelson DP, Abella BS, Kramer-Johansen J, Wik L, Myklebust H, Barry AM; et al. (2006). "Effects of compression depth and pre-shock pauses predict defibrillation failure during cardiac arrest". Resuscitation. 71 (2): 137–45. doi:10.1016/j.resuscitation.2006.04.008. PMID 16982127.
  6. ↑ Eftestøl T, Sunde K, Steen PA (2002). "Effects of interrupting precordial compressions on the calculated probability of defibrillation success during out-of-hospital cardiac arrest". Circulation. 105 (19): 2270–3. PMID 12010909.


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