Pulseless electrical activity resident survival guide
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahmoud Sakr, M.D. [2]
Definition
Causes
Life Threatening Causes
Common Causes
Management
Below is an algorithm summarizing the approach to a patient with pulseless electrical activity. Based on the 2010 American heart association ACLS algorithm for PEA[1]
Do's
- Efficiency of CPR can be determined by
- Monitoring of chest compression rate and depth
- Adequacy of chest wall relaxation
- Length and duration of pauses in compression and number and depth of ventilations delivered
- Physiologic parameters; partial pressure of end-tidal CO2 [PETCO2], arterial pressure during the relaxation phase of chest compressions, central venous oxygen saturation [ScvO2]
- Remember that the foundation of successful ACLS is good BLS , represented in prompt high-quality CPR with minimal interruptions.[2][3]
- A new class I recommendation is the use of quantitative waveform capnography for confirmation and monitoring of endotracheal tube placement.
- Supraglottic advanced airways continues to be an alternative to endotracheal intubation for airway management during CPR.
Don'ts
- Don't routinely use cricoid pressure during airway management of patients in cardiac arrest.
- Don't routinely administer atropine in the management of pulseless asystole.
References
- ↑ Field JM, Hazinski MF, Sayre MR, Chameides L, Schexnayder SM, Hemphill R; et al. (2010). "Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 122 (18 Suppl 3): S640–56. doi:10.1161/CIRCULATIONAHA.110.970889. PMID 20956217.
- ↑ Edelson DP, Abella BS, Kramer-Johansen J, Wik L, Myklebust H, Barry AM; et al. (2006). "Effects of compression depth and pre-shock pauses predict defibrillation failure during cardiac arrest". Resuscitation. 71 (2): 137–45. doi:10.1016/j.resuscitation.2006.04.008. PMID 16982127.
- ↑ Eftestøl T, Sunde K, Steen PA (2002). "Effects of interrupting precordial compressions on the calculated probability of defibrillation success during out-of-hospital cardiac arrest". Circulation. 105 (19): 2270–3. PMID 12010909.