Megacode PEA Part 2

PEA mnemonic:  Keep them ALIVE

A- assess ABCs

L- listen for pulse using doppler

I- Initiate CPR

V- vasoconstrictors

E- evaluate reversable causes

Assess ABCs- Primary Survey

·         Assess responsiveness and pulse

·         Active EMS system

·         Call for defibrillator/monitor

Note:  If a rhythm is present on the monitor but the pulse is absent (eg,PEA), CPR should be started immediately, beginning with chest compressions, and should continue for 2 minutes before the rhythm check is repeated.

Listen for Pulse Using Doppler

·         A doppler will help distinguish between a pulseless state and profoundly weak cardiac contractions with a low cardiac output (pseudo-PEA).

·         True PEA:  no pulse and no perfusion

·         Pseudo-PEA: weak pulse detected by doppler or echocardiography and severely compromised perfusion

Initiate CPR

·         Compress chest at least 2 inches

·         Allow for full chest recoil

·         Compression to ventilation ratio 30:2

·         Compression rate of 100/minute

·         Avoid hyperventilation

3:22 PM  CPR is in progress.  The positive pressure ventilations went in easily, suggesting a patent airway.  Since the ventilations were easy, there was no point in intubating the patient at this time.   The rhythm on the monitor shows some agonal beats as well as some artifact from the CPR.  Epinephrine 1mg IV push has been given followed by a saline flush.

3:24 PM The patient remains pulseless and apneic after the initial dose of epinephrine.    CPR is in progress.  The two vasoconstrictors that you can consider for PEA are either epinephrine or vasopressin.   Recall that vasopressin can be administered as a one time dose before epinephrine or as a one time dose after epinephrine.  Studies show no benefit to administering a second dose of vasopressin.