Lecture Notes: Pulseless Electrical Activity (PEA)

Overview

• Definition: PEA or Pulseless Electrical Activity is a condition where there is electrical activity in the heart but no pulse.
• Clinical Status: Patient is in cardiac arrest but shows a heart rhythm that should produce a pulse on a monitor.

EKG Interpretation

• Rate: Can be bradycardic, normal, or tachycardic.
• Rhythm: Regular.
• P Wave: Present and normal.
• PR Interval: Normal.
• QRS Waves: Present.
• Appearance on EKG: Often resembles normal sinus rhythm but there's no pulse.

Causes of PEA

The Six H's

1. Hyperkalemia: High potassium.
2. Hypoxia: Low oxygen.
3. Hypothermia: Low body temperature.
4. Hydrogen Ion Excess: Acidosis (metabolic or respiratory).
5. Hypovolemia: Low fluid volume.
6. Hypoglycemia: Low blood sugar.

The Six T's

1. Tamponade: Blood in the sac around the heart.
2. Tension Pneumothorax: Pressure in the thoracic cavity affecting lungs.
3. Thrombosis: Blood clot, e.g., pulmonary embolism.
4. Toxins: Medication toxicity, notably digoxin toxicity.
5. Trauma: Physical injury leading to PEA.

Common Feature

• Decreased Cardiac Output: Lack of oxygen delivery to the body.

Signs and Symptoms

• Patient is clinically dead: unconscious, cold, no pulse or blood pressure, and not breathing.

Nursing Interventions and Treatments

• Immediate Actions: Call a code, start CPR, intubate the patient, and use ACLS protocols.
• Medications:
  • Atropine: To increase heart rate if rhythm is bradycardic (<60 bpm).
  • Vasopressin and Epinephrine: To increase blood pressure by vasoconstriction, improving cardiac output and oxygen delivery.
  • Mnemonic for Medication: PEA - "Push Epi Always" (1 mg IV every 3-5 minutes during arrest).

Defibrillation

• Not Applicable: PEA is not a shockable rhythm because the heart's electrical system is functional. Shocking is used to reset faulty rhythms, not applicable here.