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Code Management: PEA

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Brief review of the ACLS pulseless algorithm for PEA for ICU nurses.

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Code Management: PEA

  1. 1. CODE MANAGEMENT Pulseless Electrical Activity (PEA)
  2. 2. PEA OBJECTIVES: • Define PEA • Narrow Complex PEA • Wide Complex PEA • ACLS Cardiac Arrest Algorithm for PEA • ACLS Post Cardiac Arrest Care Algorithm
  3. 3. PEA What is PEA? • PEA is defined as, “…spontaneous organized cardiac electric activity in the absence of blood flow sufficient to maintain consciousness and absence of a rapid spontaneous return of adequate organ perfusion and consciousness.” Circulation. 2013;128:2532-2541 • https://doi.org/10.1161/CIRCULATIONA HA.113.004490
  4. 4. PEA What can cause PEA? • PEA is the result of underlying pathological process. What is the goal of care? • Resolution of the ‘cause’ or ‘problem’ is essential for ROSC.
  5. 5. PEA • In ACLS the Hs & Ts are used to describe possible causes of a PEA arrest. • However, the patient’s history and EKG can help guide interventions. • Furthermore, for admitted hospital patients there are specific common causes of a PEA arrest (Littman et al).
  6. 6. PEA Narrow QRS Cardiac Tomponade • Pericardialcentesis Pneumothorax • Needle Decompression • Chest Tube Massive PE • TPA 50-100mg IV Volume Loss • IV Fluids • Blood Products • Massive Transfusion Wide QRS Hyperkalemia •D50W amp + Hum “R” 5- 10 units •NaHCO3- IV •CaCl IV Acidosis • Increase ventilation (↓CO2) • NaHCO3- IV MI •Cath Lab •TNK Toxins • Specific antidote • CCB / Beta Blocker / TCA
  7. 7. PEA What do I need to know? • You do not shock PEA • CPR 30:2 (minimize interruptions) • Epinephrine 1mg IV or IO q3-5 minutes • Atropine 0.5-1mg IV or IO (in rare cases) • Fix the problem! • If ROSC → Post Cardiac Arrest Algorithm • If VF / VT → VF / VT Algorithm
  8. 8. PEA
  9. 9. PEA What happens if we achieve ROSC? • Prepare to manage Post Cardiac Arrest Syndrome. • Occurs with the return of spontaneous circulation. • Ischemia and reperfusion injury can cause vasodilation (low BP). • Cardiac dysfunction and pump failure (dilated cardiomyopathy). • Post cardiac arrest brain injury. • Severity depended on duration of code and patient history.
  10. 10. PEA How do I manage Post Cardiac Arrest Syndrome? • Airway management • Sedation • Levophed Infusion • Antiarrhythmic Agents • Labs / CXR / CT • Transfer to ICU, OR, or Cath Lab. • Consider cooling the patient
  11. 11. PEA References:  ACLS 2015 PEA and Post Cardiac Arrest guidelines  CC 90-015 – D http://policy.nshealth.ca/Site_Published/DHA9/document_render.aspx?docum entRender.IdType=6&documentRender.GenericField=&documentRender.Id=53 045  Pulseless Electrical Activity, Circulations, 2013;128;2532-2541 http://circ.ahajournals.org/content/128/23/2532.short  A Simplified and Structured Teaching Tool for the Evaluation and Management of Pulseless Electrical Activity, Medical Principals & Practice, 2014;23:1-6 https://www.karger.com/Article/FullText/354195  Post Cardiac Arrest Syndrome A Review of Therapeutic Strategies, Circulation, 2011;123:1428-1435. http://circ.ahajournals.org/content/123/13/1428

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