Pulseless electrical activity (patient information)
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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 |
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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 prompt defibrillation with an AED are important factors in determining patient outcome after out-of-hospital SCA. Survival after SCA is greater among those who have bystander CPR when compared with those who initially receive more delayed CPR from EMS personnel
Possible complications
The following complications are likely to be 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