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Pals H And T


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Presentation on causes for Pulsless Electrical Activity in Children

Published in: Health & Medicine
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Pals H And T

  1. 1. P.A.L.S. Bradycardia and P.E.A.
  2. 2. Bradycardia <ul><li>With or without a pulse </li></ul><ul><li>HR < 60/min </li></ul><ul><li>Poor perfusion? </li></ul><ul><li>Rule out possible causes! </li></ul><ul><li>Epinephrine IV/IO 0.01mg/kg </li></ul><ul><li>Atropine 0.02mg/kg max 1mg </li></ul><ul><li>Consider pacing </li></ul>
  3. 3. Pulseless Electrical Activity <ul><li>The absence of a detectable pulse and the presence of some type of electrical activity other than Ventricular Tachycardia or Ventricular Fibrillation </li></ul><ul><li>Can represent the last electrical activity of a dying myocardium or may indicate specific critical rhythm disturbances </li></ul>
  4. 4. Pulseless Electrical Activity <ul><li>The one major action that must be taken in the presence of PEA is to search for possible causes! </li></ul><ul><li>H’s and T’s </li></ul>
  5. 5. H’s and T’s <ul><li>Hypovolemia </li></ul><ul><li>Hypoxia </li></ul><ul><li>Hydrogen Ion (acidosis) </li></ul><ul><li>Hypo/Hyperkalemia </li></ul><ul><li>Hypoglycemia </li></ul><ul><li>Hypothermia </li></ul><ul><li>Toxins </li></ul><ul><li>Tamponade </li></ul><ul><li>Tension Pneumothorax </li></ul><ul><li>Thrombosis (coronary or pulmonary) </li></ul><ul><li>Trauma </li></ul>
  6. 6. Hypovolemia <ul><li>Will present with an increased electrical rate, look for root cause. </li></ul><ul><ul><li>Provide a rapid 20ml/kg bolus of isotonic crystalloid </li></ul></ul>
  7. 7. Hypoxemia/Hypoxia <ul><li>Check airway of patient, if intubated use the D.O.P.E. mnemonic: </li></ul><ul><ul><li>D: Displacement of tracheal tube </li></ul></ul><ul><ul><li>O: Obstruction of tracheal tube </li></ul></ul><ul><ul><li>P: Pneumothorax </li></ul></ul><ul><ul><li>E: Equipment failure </li></ul></ul>
  8. 8. Hypothermia <ul><li>Will present with a slow electrical rate </li></ul><ul><li>Core temps less than 32.2°C may require rapid re-warming </li></ul><ul><li>Could result in a cardiac collapse rhythm </li></ul>
  9. 9. Hypoglycemia <ul><li>Commonly associated with poor outcome in critically ill children </li></ul><ul><ul><li>Check glucose during resuscitation </li></ul></ul><ul><ul><li>Infants and children have a limited stores of glycogen that may be rapidly depleted during physiologic stress </li></ul></ul>
  10. 10. Hypoglycemia <ul><li>Clinical signs may mimic hypoxemia and ischemia preceding cardiac arrest </li></ul><ul><li>Glucose is a major metabolic substrate for the neonatal myocardium. Hypoglycemia may depress neonatal myocardial function </li></ul>
  11. 11. Hypoglycemia <ul><li>Although fatty acids normally function as the major metabolic substrate for the myocardium of older infants and children, glucose provides a significant energy source during episodes of ischemia </li></ul>
  12. 12. Hyper/hypokalemia and metabolic disorders <ul><li>Correct severe electrolyte imbalance (potassium, calcium, magnesium) </li></ul><ul><li>Acidosis (hydrogen) </li></ul><ul><li>Rate can be fast or slow, changes in morphology of qrs </li></ul>
  13. 13. Tamponade <ul><li>Initial presentation will be tachy </li></ul><ul><li>Treated with volume bolus and pericardiocentesis </li></ul>
  14. 14. Tension Pneumothorax <ul><li>Treat with needle decompression </li></ul>
  15. 15. Toxins <ul><li>Will require certain specific therapies </li></ul><ul><ul><li>E.g. Sodium Bicarbonate for tricyclic antidepressant overdose </li></ul></ul>
  16. 16. Thromboembolism <ul><li>If severe enough to cause a collapse rhythm it will be rare and difficult to treat </li></ul>
  17. 17. Pulseless Electrical Activity <ul><li>The ECG may provide clues: </li></ul><ul><ul><li>QRS complexes may initially appear normal, particularly in problems of short duration like hypovolemia, pulmonary embolism, tension pneumothorax or cardiac tamponade </li></ul></ul>
  18. 18. Pulseless Electrical Activity <ul><li>Wide complex, slow rhythm PEA is more often seen in processes of longer duration such as tissue hypoxia and acidosis </li></ul>