![]() ![]() In patients with pseudo PEA, the ability of the cardiovascular system to generate "forward flow" is impeded despite the continued presence of myocardial contractions. Pseudo PEA, which occurs when cardiac electrical activity is demonstrated but a palpable pulse is absent, is diagnosed when myocardial contractions are noted via echocardiography or some other imaging modality. In true PEA, cardiac electrical activity in the form of a rhythm is noted, yet absolutely no mechanical contraction of the heart is occurring-hence, the absence of pulse and perfusion. "TRUE" VERSUS "PSEUDO" PEA It is important to distinguish between the "true" and "pseudo" subtypes of PEA. Essentially, any cardiac arrest rhythm (ie, any dysrhythmia unaccompanied by a pulse) other than ventricular tachycardia or VF may be seen in a patient with PEA. ![]() PEA is characterized by the unique combination of an absence of discernible cardiac mechanical activity (ie, a "pulseless" state) with persistent cardiac electrical activity (ie, the cardiac rhythm). A slow, wide-QRS-complex rhythm is associated with little chance of survival.ĬORRECT ANSWER: BPulseless electrical activity (PEA) is a malignant dysrhythmia that reflects a serious underlying medical event. A rapid, narrow-QRS-complex rhythm is associated with an improved chance of survival. "True" and "pseudo" subtypes of PEA have similar causes and outcomes. The cardiac rhythm can be used to guide therapy in resuscitation. Which statement about such patients is not true?Ī. Advanced life support care is continued.īoth these patients exhibit PEA cardiac arrest rhythms. Total downtime was approximately 20 minutes. After defibrillation, the post-countershock rhythm was a wide-QRS-complex, regular rhythm without pulse ( Figure 1 ), which persisted at the time of ED arrival. ![]() Emergency medical personnel initiated appropriate care for ventricular fibrillation (VF), including cardiopulmonary resuscitation, airway management, defibrillation, intravenous medications, and intravenous fluids. She has a history of myocardial infarction (MI) congestive heart failure, with an ejection fraction of 0.15 and chronic renal failure. At home, she was found unresponsive, pulseless, and apneic. Resuscitation continues.Ĭase 2: A 76-year-old woman with cardiac arrest is brought to the emergency department (ED) via ambulance. In addition to standard advanced life support management, normal saline is rapidly infused via a central venous line followed by 4 units of packed red blood cells. Treatment is started with attention to the airway, breathing, and circulation. The patient's hematocrit on admission was 39% (with a healthy baseline value of 46%) the hematocrit just before the arrest was 31%. The ECG monitor shows a rapid, narrow-QRS-complex tachycardia with obvious P-wave activity, which in this case represents pulseless electrical activity (PEA) ( Figure 1 ). Cardiac arrest occurs while he awaits an upper esophagogastroduodenoscopy he immediately becomes unresponsive, apneic, and pulseless. Case 1: A 46-year-old man with melena is admitted to the ICU. ![]()
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