Cardiology In Critical Care

Lethal Dysrhythmias of the Heart

Pulseless Electrical Activity (PEA)

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Pulseless Electrical Activity

A. Patient has electrical activity on the ECG, but no mechanical heart contractions to pump blood. includes:

1. Electromechanical dissociation (EMD) Pseudo-EMD

2. ldioventricular rhythms

3.Ventricular escape rhythms

4. Bradyasystohc rhythms

5. Postdefibrillation idioventricular rhythms

B. Clinical significance - no ventricular contractions, so no cardiac output. May be due to:

1. Hypovolemia
2. Hypoxia
3. Cardiac tamponade
4. Tension pneumothorax
5. Hypothermia
6. Massive puhmonary embolism
7. Drug overdoses such as tricyclics, dig, beta-blockers, calcium channel
8. Hyperkalemia
9. Acidosis
10 Massive acute myocardial infarction

C. Characteristics - ECG may show rinus rhythm, junctional rhythm or a other rhythm with QRS complexes, but the patient has no pulse and no B/P.

D. Treatment

1. Start CPR, intubate at once, obtain IV access, assess blood flow using Doppla ultrasound

2. Deterniine the underlying cause.

3. Pericardiocentesis if due to tamponade.

4. Chest tube if due to tension pneumothorax.

5. Fluid challenge.

6. Epinephrine every 3-5 minutes. Atropine if bradycardia oeems.

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