Pulseless Electrical Activity

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Contents 1 Introduction 2 Etiology 3 Management 4 More General Terms 5 References

Introduction

• Alias electromechanical dissociation. ECG electrical activity other than VF/ VT
• electromechanical dissociation
• idioventricular rhythms
• ventricular escape rhythms
• bradyasystolic rhythm
• postdefibrillation idioventricular rhythms

Etiology

• hypovolemia
• hypoxemia
• cardiac tamponade
• tension pneumothorax
• hypothermia
• massive pulmonary embolus
• drug overdose
• hyperkalemia
• severe acidosis
• massive acute myocardial infarction

Management

• assess for presence of pulse, begin CPR if no pulse
• cardiac monitor to assess rhythm
• use Doppler to assess blood flow

• if blood flow, treat for severe hypotension
• if no blood flow continue CPR

• establish IV access
• intubate (IV/ IO access takes precedence over intubation)
• consider possible causes & treat
• epinephrine 1 mg IV push every 3-5 min
• atropine no longer recommended [2]
• adenosine may be used [2]
• if no response

• high dose epinephrine *
• NaHCO3 if appropriate #
  

• * high dose epinephrine: 2-5 mg IV push every 3-5 min; 1 mg, 3 mg, 5 mg 3 minutes apart; 0.1 mg/kg every 3-5 min
  
• # NaHCO3 not indicated early in resuscitation, acidosis is generally secondary to inadequate ventilation, dose is 1 meq/kg IV followed by 0.5 meq/kg every 10 min

More General Terms

• cardiac arrhythmia

References

1. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 180
2. American Heart Association Guidelines for CPR and Emergency Cardiovascular Care Oct. 18, 2010 Comparison Chart of Key Changes [1]

pulseless electrical activity (PEA, electromechanical dissociation)