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Pulseless electrical activity
 
 
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Pulseless Electrical Activity (also known by the older term Electromechanical Dissociation or Non-Perfusing Rhythm) refers to any heart rhythm observed on the electrocardiogram
Electrocardiogram

An electrocardiogram is a recording of the electricity activity of the heart over time produced by an electrocardiograph, usually in a Non-invasive recording via skin electrodes....
 that should be producing a pulse
Pulse

In medicine, a person's pulse is the throbbing of their artery. It can be palpated in any place that allows for an artery to be compressed against a bone, such as at the neck , at the wrist , behind the knee , on the inside of the elbow , and near the ankle joint ....
, but is not. The condition may or may not be caused by electromechanical dissociation. The most common cause is hypovolemia
Hypovolemia

In physiology and medicine, hypovolemia is a state of decreased blood volume; more specifically, decrease in volume of blood plasma. Volumetric thirst can be caused by a number of things including bleeding and diarrhea....
.

The normal condition when electrical activation of muscle cells precedes mechanical contraction is known as Electromechanical Coupling.

approach in treatment of PEA is to treat the underlying cause.






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Encyclopedia


Pulseless Electrical Activity (also known by the older term Electromechanical Dissociation or Non-Perfusing Rhythm) refers to any heart rhythm observed on the electrocardiogram
Electrocardiogram

An electrocardiogram is a recording of the electricity activity of the heart over time produced by an electrocardiograph, usually in a Non-invasive recording via skin electrodes....
 that should be producing a pulse
Pulse

In medicine, a person's pulse is the throbbing of their artery. It can be palpated in any place that allows for an artery to be compressed against a bone, such as at the neck , at the wrist , behind the knee , on the inside of the elbow , and near the ankle joint ....
, but is not. The condition may or may not be caused by electromechanical dissociation. The most common cause is hypovolemia
Hypovolemia

In physiology and medicine, hypovolemia is a state of decreased blood volume; more specifically, decrease in volume of blood plasma. Volumetric thirst can be caused by a number of things including bleeding and diarrhea....
.

The normal condition when electrical activation of muscle cells precedes mechanical contraction is known as Electromechanical Coupling.

Causes

The approach in treatment of PEA is to treat the underlying cause. These possible causes are remembered as the Hs and Ts.
  • Hypovolemia
    Hypovolemia

    In physiology and medicine, hypovolemia is a state of decreased blood volume; more specifically, decrease in volume of blood plasma. Volumetric thirst can be caused by a number of things including bleeding and diarrhea....
  • Hypoxia
    Hypoxia (medical)

    Hypoxia is a Pathology condition in which the body as a whole or a region of the body is deprived of adequate oxygen supply. Variations in arterial oxygen concentrations can be part of the normal physiology, for example, during strenuous physical exercise....
  • Hydrogen
    Hydrogen

    Hydrogen is the chemical element with atomic number 1. It is represented by the chemical symbol H. At standard temperature and pressure, hydrogen is a colorless, odorless, nonmetallic, tasteless, highly combustion and explosive Diatomic molecule gas with the molecular formula H2....
     ions (Acidosis
    Acidosis

    Acidosis is an increased acidity . If not further qualified, it usually refers to acidity of the blood plasma.Acidosis is said to occur when arterial pH falls below 7.35, while its counterpart occurs at a pH over 7.45....
    )
  • Hypothermia
    Hypothermia

    Hypothermia is a condition in which an organism's temperature drops below that required for normal metabolism and bodily functions. In warm-blooded animals, core body temperature is maintained near a constant level through biologic homeostasis....
  • Hyperkalemia
    Hyperkalemia

    Hyperkalemia Hyperkalaemia is an elevated blood level of the electrolyte potassium. The prefix hyper- means high . The middle kal refers to kalium, which is neo-Latin for potassium....
     or Hypokalemia
    Hypokalemia

    Hypokalemia refers to the condition in which the concentration of potassium in the blood is low. The prefix hypo- means low . Kal refers to kalium, the Neo-Latin for potassium, and -emia means "in the blood."...
  • Hypoglycemia
    Hypoglycemia

    Hypoglycaemia or hypoglycemia is the medical term for a Pathology state produced by a lower than normal level of Blood glucose. The term hypoglycemia literally means "under-sweet blood" ....
  • Tablets or Toxins (Drug overdose
    Drug overdose

    The term drug overdose describes the ingestion or application of a drug or other substance in quantities greater than are recommended or generally practiced....
    )
  • Cardiac Tamponade
    Cardiac tamponade

    Cardiac tamponade, also known as pericardial tamponade, is an medical emergency condition in which fluid accumulates in the pericardium . If the fluid significantly elevates the pressure on the heart it will prevent the Ventricle from filling properly....
  • Tension pneumothorax
    Tension pneumothorax

    A tension pneumothorax is a life-threatening condition that results from a progressive deterioration and worsening of a simple pneumothorax, associated with the formation of a Check valve at the point of a rupture in the lung....
  • Thrombosis
    Thrombosis

    Thrombosis is the formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel is injured, the body uses platelets and fibrin to form a blood clot, because the first step in repairing it is to prevent loss of blood....
     (Myocardial infarction
    Myocardial infarction

    Myocardial infarction , commonly known as a heart attack, occurs when the Blood flow to part of the heart is interrupted. This is most commonly due to occlusion of a coronary artery following the rupture of a Vulnerable plaque, which is an unstable collection of lipids and white blood cells in the wall of an artery....
    )
  • Thrombosis
    Thrombosis

    Thrombosis is the formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel is injured, the body uses platelets and fibrin to form a blood clot, because the first step in repairing it is to prevent loss of blood....
     (Pulmonary embolism
    Pulmonary embolism

    Pulmonary embolism is a blockage of the pulmonary artery or one of its branches, usually occurring when a deep vein thrombosis becomes dislodged from its site of formation and travels, or embolism, to the pulmonary artery blood supply of one of the lungs....
    )
  • Trauma
    Physical trauma

    Physical trauma refers to a body injury. A trauma patient is someone who has suffered serious and life-threatening physical injury with the potential for secondary complications such as Shock , respiratory failure and death....
     (Hypovolemia
    Hypovolemia

    In physiology and medicine, hypovolemia is a state of decreased blood volume; more specifically, decrease in volume of blood plasma. Volumetric thirst can be caused by a number of things including bleeding and diarrhea....
     from blood loss)


Treatment

Where an underlying systemic cause is unable to be determined in sufficient time, pulseless electrical activity should receive treatment methods as if the patient were in asystole
Asystole

In medicine, asystole is a state of no heart electrical activity, hence no contractions of the myocardium and no cardiac output or blood flow. Asystole is one of the conditions required for a medical practitioner to certify death....
. Treatment is intravenous delivery Epinephrine
Epinephrine

Epinephrine is a hormone and neurotransmitter.Epinephrine increases the "fight or flight" response of the Sympathetic nervous system of the autonomic nervous system....
 1 mg every 3-5 minutes, and, if the underlying rhythm is bradycardia
Bradycardia

Bradycardia , as applied to adult medicine, is defined as a resting heart rate of under 60 beats per minute, though it is seldom symptomatic until the rate drops below 50 beat/min....
, Atropine
Atropine

Atropine is a tropane alkaloid extracted from deadly nightshade , jimsonweed , Mandrake and other plants of the family Solanaceae. It is a secondary metabolite of these plants and serves as a hard drug with a wide variety of effects....
 1 mg IV up to .04 mg/kg (varies with regional protocols). Both these drugs should be administered along with appropriate CPR techniques. Defibrillators are not used for this rhythm, as the problem lies in the response of the myocardial tissue to electrical impulses.