Pulseless Arrest - Management of PEA/Asystole

high quality CPR and address underlying cause

give epi!

Treatment of pulseless arrest in general

perfusion

PEA only exists in rhythms that would normally cause ______

perform CPR for 2 min

obtain IV/IO access

epinnephrine 1mg every 3-5 min

advanced airway

reevaluate rhythm

If patient does NOT have a shockable rhythm what must you do?

hypovolemia

hypoxia

hydrogen ion

hypo/hyperkalemia

hypothermia

hypoglycemia

H’s?

toxins

tension pneumo

tamponade

thrombus (MI or PE)

trauma

T’s?

hypovolemia

What is probably the most common H?

hypoxia

Very common cause and may present with mental status changes prior to any changes in the oxygen tension- be wary of the patient who suddenly becomes combative

hydrogen ion excess

Consider with diabetes, renal failure- Tx with ventilation, bicarb

hypo/hyperkalemia

Consider with renal failure, NPO status and lack of replacement, recent dialysis, medications

Tx: calcium chloride, bicarb (less), glucose + insulin, possible albuterol (takes too long for Kexalate resins)

Add magnesium if hypokalemic + cardiac arrest

hypothermia

Environment of the patient, wetness added to the cold increases injury, are Osborne waves present?

Better to obtain core temperature (esophagus, rectum, bladder thermometers)

toxins

◦Pupil size, bradycardia, mental status changes, bottles at bedside

◦Give specific antidote, if available; may need to intubate if respirations are suppressed

tension pneumothorax

◦Neck vein distention, tracheal deviation, decreased/nonexistent breath sounds, hard to ventilate patient

cardiac tamponade

◦No pulse felt with CPR, distended neck veins

◦Treat with pericardiocentesis, pericardial window

pulmonary throbosis

◦Saddle embolism obstructs flow to pulmonary vasculature and causes acute right-sided heart failure (may cause instant death if large enough)- fibrinolytics may be lifesaving in this scenario; ECMO

coronary thrombosis

◦History, EKG, cardiac markers (may not be that helpful).  Cath Lab?  ECMO?

trauma

Stop the bleeding, Fluids

asystole

patient is in cardiac arrest and has no pulse with straight line on monitor

fine VF

Ensure asystole is really a flat line and not ______

begin chest compressions

What should be done immediately for asystole?

extremely poor

What is survival looking like for asystole?

agonal rhythm

Asystole can be an ____ _____ confirming death rather than a rhythm that needs to be treated

myocardial damage

Persistent asystole can represent extensive myocardial damage from _____ _____ _____ ______

epinephrine

What is the only indicated med for asystole?

10 seconds or less

CPR interruptions should be how long?

IV and IO placement

What is placed as priority over advanced airway placement unless basic airway resuscitation is ineffective or if the arrest is caused by hypoxia?

What is this rhythm?

What is this rhythm?