Page 87 - Radiology Book

Pulseless electrical activity (Pea)
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Follow Universal Algorithm for
PRIMARY SURVEY - CABD SECONDARY SURVEY - CABD
PEA ON MONITOR
Any semiorganized electrical activity that can be seen on the monitor although the patient lacks a palpable pulse (not VF, VT or asystole).
HIGH-QUALITY CPR
· CPR for 2 minutes
· Epinephrine 1 mg IV push, repeat
every 3–5 minutes
· IV/IO access
· Advanced airway
· Look for reversible causes
HIGH QUALITY CPR
· Push hard and fast
(100 compressions/minute).
· Minimize chest compression interruptions and allow full recoil of the chest wall.
· One cycle of CPR consists of 30 chest compressions followed by 2 breaths; 5 cycles is approximately 2 minutes long when no advanced airway is present.
· Avoid hyperventilation: deliver 10 breaths/minute or one breath every 6 seconds.
· Rotate compressors every 2 minutes (with rhythm checks).
· Once airway is placed: discontinue CPR cycles; provide continuous chest compressions without pauses until ventilation ensues.
NO RHYTHM SHOCKABLE? YES
CONTINUE HIGH-QUALITY CPR
· Treat reversible causes of PEA GO TO VF/pVT
· CPR for 2 minutes prior to next rhythm check
ALGORITHM
NO RHYTHM SHOCKABLE? YES CONTINUE HIGH QUALITY CPR, search for reversible causes
5 Hs
· Hypovolemia
· Hypoxia
· Hydrogen ion (acidosis) · Hypo-/hyperkalemia
· Hypothermia
5 Ts
· Toxins (drugs; OD or accidental) · Tamponade, cardiac
· Tension pneumothorax
· Thrombosis, coronary (ACS)
· Thrombosis, pulmonary embolism
RETURN OF SPONTANEOUS CIRCULATION (ROSC)
Pulse and BP; abrupt sustained in PETCO2 (typically ≥ 40 mmHg) or spontaneous atrial pressure waves with intra-arterial monitoring
POST CARDIAC ARREST CARE
· Optimize ventilation and oxygenation
· · · · · ·
Maintain oxygen saturation ≥ 94%
Do not hyperventilate
Treat hypotension (SBP <90 mmHg)
IV/IO bolus, pressors, look for treatable causes
Does patient follow commands? If not, consider inducing hypothermia
Get EKG. If STEMI or high suspicion of AMI, consider coronary reperfusion
Adapted from Circulation. 2015;132:S444-S464
ACLS