Pulseless Electrical Activity (PEA)
Section 4 - CARDIAC
4.04 PULSELESS ELECTRICAL ACTIVITY (PEA)
CONSIDER MEDICAL ETIOLOGY OF PEA AND REFER TO APPROPRIATE PRACTICE PARAMETER:
- Hypovolemia, SHOCK (5.13).
- Tension Pneumothorax, CHEST INJURIES (6.04).
- Hypoxia / Acidosis, INITIAL MEDICAL CARE (2.01).
- Hypothermia, COLD EMERGENCIES (5.06).
- Hypoglycemia, HYPO/HYPERGLYCEMIA (5.10)
- Toxins, DRUG OVERDOSE/POISONING (5.05)
- Initiate 5 cycles of CPR (30:2) for approximately 2 minutes to allow blood to circulate and continue throughout resuscitation, minimizing interruptions. Assist ventilations with OXYGEN @ 100% via BVM. DO NOT HYPERVENTILATE.
- Consider securing the airway with KING TUBE / INTUBATION and establish IV or IO.
- If hypovolemia suspected, fluid bolus 200 - 300 ml. If time permits.
If bradycardia, relative bradycardia or vagally stimulated such as patients found in the restroom.
- First, ATROPINE SULFATE 0.5 -1.0 mg rapid IVP. Repeat every 3 - 5 minutes up to a total of 3 mg.
- Apply TCP, set at maximum Milliamp. If pulse generated, decrease dosage to setting which still maintains a palpable pulse. If unsuccessful, reattempt capture every 3 - 5 minutes as above. Check for pulse and rhythm change after all interventions.
- EPINEPHRINE 1:10,000 1 mg IVP or IO Repeat EPINEPHRINE every 3 - 5 minutes of continued arrest.
If NO bradycardia or relative bradycardia
- VASOPRESSIN 20 units IVP. (Alternate with) EPINEPHRINE 1:10,000 1 mg IVP / IO
- Repeat for a second dose. Continue EPINEPHRINE every 3-5 minutes of arrest.
- Repeat EPINEPHRINE every 3 - 5 minutes of continued arrest.
If patient combative post resuscitation, refer to ANALGESIA /SEDATION PARAMETER (2.04).