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PEA
PEA case
| Question | Answer |
|---|---|
| The patient has organized electrical activity but no pulse. What do you do (5 things)? | CPR for 2 minutes; Gain IV/IO access; give epinephrine every 3-5 minutes (Vaspressin 40 units 1st or 2nd dose); consider advanced airway and capnograph, Check rhythm/pulse |
| After 2 minutes of CPR the patient still has organized rhythm and no pulse or asystole. What do you do? | continue CPR for 2 minutes; Treat reversible causes; Check for shockable rhythm |
| What is the most effective course of action in most cases of PEA? | Find and treat the underlying cause |
| What four things should be considered while trying to discover the underlying cause of PEA? | H’s and T’s; ECG for clues; recognize Hypovolemia (heart’s pumping but not enough fluid to pump); recognize drug overdose/poisoning |
| Name the H’s and T’s. | Hypovolemia, Hypoxia, Hydrogen Ion (Acidosis), Hyper/hypokalemia, Hypothermia, Tension, Tamponade –cardiac, Toxins, Thrombosis (pulmonary or coronary) |
| What ECG findings would point to possible hypovolemia? | Narrow complex, rapid rate |
| What history and Physical exam findings are congruent with hypovolemia? | flat neck veins, poor skin turgor, rapid heart rate, poor intake or excessive output |
| How do you fix hypolvemia? | volume infusion |
| What ECG findings should lead you to consider hypoxia as the cause? | Slow rate |
| What H & P findings would indicate hypoxia as the cause of PEA? | cyanosis, blood gases, airway problems |
| What do you do to fix hypoxia? | oxygenation, ventilation, advanced airway |
| What ECG findings might be an indication of acidosis? | smaller amplitude QRS complexes |
| What clues from H&P would lead you to think about acidosis? | DM, renal failure, bicarbonate responsive acidosis |
| What are the fixes for acidosis? | ventilation, sodium bicarbonate |
| What will the ECG tell you if the patient has hyperkalemia? | Tall peaked Twaves, small p waves, widened QRS, sine-wave PEA |
| What clues from H&P could suggest hyperkalemia as the cause of PEA? | renal failure, DM, recent dialyisi, dialysis fistulas, medications, cell damage |
| What are the effective interventions for hyperkalemia? | calcium chloride; sodium bicarbonate, glucose plus insulin, possibly albuterol |
| What an ECG look like if hypokalemia was the cause? | Twaves flatten, prominent U waves, widened QRS, prolonged QT, wide complex tachycardia |
| What H&P findings indicate the possibility of hypokalemia? | Prolonged N&V, diarrhea, diuretic use |
| What is the fix for hypokalemia? | Replace potassium and magnesium if cardiac arrest |
| What ECG findings indicate Hypothermia? | J or Osborne waves |
| What H&P findings indicate hypothermia? | exposure to cold, temperature |
| What might an ECG look like if the patient has tension pneumothorax? | Narrow complex, slow rate (due to hypoxia) |
| What signs and symptoms might be assessed if the patient has tension pneumothorax? | no pulse with CPR, neck vein distention, tracheal deviation, unequal breath sounds, difficult to ventilate |
| What are the interventions for tension pneumothorax? | needle decompression, Tube thoracotomy |
| What would you see on the ECG monitor if the patient had cardiac tamponade? | Narrow complex, rapid rate |
| What signs might be assessed if the patient has cardiac tamponade? | no pulse with CPR, vein distention |
| What is the intervention for cardiac tamponade? | Pericardiocentesis |
| Although drug overdose and toxins will produce various ECG effects, what is the most predominant ECG finding if the patient is suffering from toxic poisoning? | QT prolongation |
| What signs during assessment might lead you to suspect toxicity? | neurologic alterations, pupils, bradycardia |
| What is the antidote for heparin? | Protamine sulfate |
| What is the antidote for Coumadin? | Vitamin K |
| What is the antidote for Digoxin? | Digibind, Digoxin Immune Fab – Digifab |
| What is the antidote for Tylenol? | Acetylcysteine (mucomyst) |
| What is the antidote for Opioids? | Narcan, Revex |
| What is the antidote for benzodiazepines (Valium)? | Flumazenil |
| What is the antidote for Atropine? | Physostigmine |
| What is the antidote for cholenergics? | Atropine |
| What is glucagon used for? | beta blocker overdose |
| What is bicarbonate used for? | acidosis, hyperkalemia, and aspirin overdose |
| What is nalaxone used for? | Opioid overdose |
| What would the ECG show in a case of pulmoray thrombosis? | Narrow complex, rapid rate |
| What would the clinical symptoms of pulmonary thrombosis be? | no pulse with CPR, distended neck veins, history of thrombosis |
| What are the interventions for pulmonary thrombosis? | surgical embolectomy or fibrinolytics |
| What alterations would be seen on the ECG with coronary embolism? | Q waves, ST segment changes, Inverted T waves |
| What clinical signs would indicate coronary thrombosis? | cardiac markers, good pulse with CPR |
| What are the two most common causes of PEA? | Hypovolemia and hypoxia |
Created by:
Perseverandovercome