Skip to main content

Using the Pulseless Arrest Algorithm for Managing PEA

Using the Pulseless Arrest Algorithm for Managing PEA

Oct 6, 2017
Version control: This document is current with respect to 2015 American Heart Association Guidelines for CPR and ECC. These guidelines are current until they are replaced on October 2020. If you are reading this page after October 2020, please contact ACLS Training Center at support@acls.net for an updated document.
Patients with PEA have poor outcomes. Their best chance of returning to a perfusing rhythm is through the quick identification of an underlying reversible cause and correct treatment. As you use the algorithm to manage the PEA patient, remember to consider all the H's and T's, particularly hypovolemia, which is the most common cause of PEA. Also look for drug overdoses or poisonings.
Begin with the primary survey to assess the patient's condition:
  1. Pulseless Electrical Activity (PEA) occurs when you see a rhythm on the monitor that would normally be associated with a pulse, however the patient is pulseless.
  2. The rhythm can be anything, at any heart rate
  3. There is something preventing the heart from generating a pulse, such as being empty (Hypovolemia) something pushing against it (Tamponade)
  4. Re-assess the patient frequently for the return of pulses
Follow the ACLS Pulseless Arrest Algorithm
  1. Begin CPR as soon as pulselessness is recognized. Continue CPR at a rate of 100 to 120 per minute throughout the resuscitation without interruptions of more than 10 seconds to evaluate for pulses.
  2. Compressors should be switched every 2 minutes to ensure efficacy of compressions
  3. Ventilate the patient using a Bag Valve Mask (or advanced airway if already in place) at a rate of 10 per minute
  4. Waveform capnography should be utilized to monitor efficacy of compressions (should generate at least 10) and the return of pulses (will cause an increase in capnography to 40)
  5. Obtain IV/IO access
  6. Administer Epinephrine 1 mg IV/IO every 3-5 minutes
  7. Find and treat underlying causes.
Two management priorities are maintaining high quality CPR and searching simultaneously for a treatable cause of the patient's PEA. Stop CPR only when absolutely necessary for pulse and rhythm checks. Establishing IV/IO access is a priority over advanced airway management. If an advanced airway is placed, change to continuous chest compressions without pauses for breaths. Give 10 breaths per minute and check rhythm every 2 minutes.
As soon as an underlying cause is identified, it should be treated. For example, if hypovolemia is identified as a possible cause of cardiac arrest, volume replacement should be started promptly. If tamponade, pericardialcentesis should occur rapidly. Without the treatment of the cause of arrest, neuro intact survival becomes unlikely.

Comments

Post a Comment

Popular posts from this blog

BASIC LIFE SUPPORT FOR INFANT

PHRONESIS MEDICARE INTERNATIONAL BLS overview for infant Basic life support (BLS) is a basic level of medical care used to help sustain a person who is experiencing cardiac arrest or respiratory failure, until they can be given full medical care by an advanced responder. BLS can be used in any scenario where breathing or heartbeat has been compromised, such as drowning, heart attack, or severe shock (eg, severe loss of blood). BLS is more comprehensive than CPR alone, since it covers additional steps that are not expected from a layperson, as well as techniques for working with other rescuers. The techniques used for BLS vary slightly depending on whether the victim is an adult, child, or infant. This module explains the techniques and procedure for performing BLS on an infant. The adult and child procedures are covered in separate modules. Note: The term 'infant' in this context refers to neonates outside the delivery room setting, up to 12 months old. Children 12...
Post a Comment
Read more

Nigeria Paramedics managing a victim of carbon monoxide poison

Carbon monoxide is a poisonous gas that has no smell or taste. Breathing it in can make you unwell, and it can kill if you're exposed to high levels. Every year there are around 25 deaths from accidental carbon monoxide poisoning in England and Wales. After carbon monoxide is breathed in, it enters your bloodstream and mixes with haemoglobin (the part of red blood cells that carry oxygen around your body), to form carboxyhaemoglobin. When this happens, the blood is no longer able to carry oxygen, and this lack of oxygen causes the body’s cells and tissue to fail and die. Symptoms of carbon monoxide poisoning The symptoms of carbon monoxide poisoning aren't always obvious, particularly during low-level exposure. A  tension-type headache  is the most common symptom of mild carbon monoxide poisoning. Other symptoms include: dizziness nausea (feeling sick) and vomiting tiredness and confusion stomach pain shortness of breath  and d...
Post a Comment
Read more

Acute Coronary Syndromes Algorithm

Acute Coronary Syndromes Algorithm Oct 6, 2017 Version control:  This document is current with respect to 2015 American Heart Association Guidelines for CPR and ECC. These guidelines are current until they are replaced on October 2020. If you are reading this page after October 2020, please contact ACLS Training Center at support@acls.net for an updated document. PDF Version  Print PDF Order the full set of printed crash cart cards  Order now  $40 Using the Acute Coronary Syndromes Algorithm for Managing the Patient The Acute Coronary Syndromes Algorithm outlines the steps for assessment and management of a patient with ACS. The algorithm begins with the assessment of chest pain and whether it is indicative of ischemia. The assessment and management begin with the EMS responder outside of the hospital who can, initiate care. An initial 12-lead ECG can also be obtained early in the assessment of the patient which will help to determine the ap...
Post a Comment
Read more