Pulseless electrical activity

Pulseless electrical activity

Infobox_Disease
Name = PAGENAME


Caption =
DiseasesDB = 4166
ICD10 = ICD10|I|46|9|I|30
ICD9 =
ICDO =
OMIM =
MedlinePlus =
eMedicineSubj = med
eMedicineTopic = 2963
MeshID =

Pulseless Electrical Activity (also known by the older term Electromechanical Dissociation or Non-Perfusing Rhythm) 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.

Causes

The approach in treatment of PEA is to treat the underlying cause. These possible causes are remembered as the Hs and Ts.cite book |author=Mazur, Glen |title=Acls: Principles And Practice |publisher=Amer Heart Assn |location= [Dallas, TX] |year=2003 |pages=p. 71-87 |isbn=0-87493-341-2 |oclc= |doi= |accessdate=] cite book |author=Barnes, Thomas Garden; Cummins, Richard O.; Field, John; Hazinski, Mary Fran |title=ACLS for experienced providers |publisher=American Heart Association |location= [Dallas, TX] |year=2003 |pages=p. 3-5 |isbn=0-87493-424-9 |oclc= |doi= |accessdate=] cite journal |author=2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care |title=Part 7.2: Management of Cardiac Arrest |journal=Circulation |year=2005 |month=December |volume=112 |issue=24 Suppl |pages=IV 58–66 |doi=10.1161/CIRCULATIONAHA.105.166557 |url=http://circ.ahajournals.org/cgi/content/full/112/24_suppl/IV-58]
* Hypovolemia
* Hypoxia
* Hydrogen ions (Acidosis)
* Hypothermia
* Hyperkalemia or Hypokalemia
* Hypoglycemia
* Hypocalcaemia
* Tablets or Toxins (Drug overdose)
* Cardiac Tamponade
* Tension pneumothorax
* Thrombosis (Myocardial infarction)
* Thrombosis (Pulmonary embolism)
* Trauma (Hypovolemia from blood loss)

Treatment

Where an underlying systemic cause is unable to be determined in sufficient time, pulseless electrical activity should receive treatment methods as if the patient were in asystole. Treatment is intravenous delivery 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. Defibrillators are not used for this rhythm, as the problem lies in the response of the myocardial tissue to electrical impulses.

References


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