P.E.A. Pulseless Electrical Activity. I call this one the ghost rhythm. The lights are on guys, but no one's home. The patient is clinically dead, but somehow there's still an electrical activity in the heart.
There should be a pulse, but no there is not. Only this pulseless electrical activity. Now technically the fancy medical definition is, the patient is in cardiac arrest.
But the monitor shows a heart rhythm that should produce a pulse, but it does not. Okay, so what is this going to look like on an EKG? Well, using our five steps, let's interpret this EKG. Step number one, the rate can be Brady, Normal, or Tacky.
The rhythm is going to be regular. The P wave will be present and normal. Same with PR interval, normal.
And the QRS waves will be present. Now honestly, this is a weird and really creepy rhythm. Because it's gonna look like normal sinus rhythm most of the time. But once you go check for a pulse, there won't be any. And that's how you know it's PEA.
Now if you're a new nurse and unfamiliar, it's gonna really like freak you out. Now hold your horses, before you start freaking out, this usually happens after a cardiac arrest workup in the hospital. So guys, all the CPR, pushing on the chest, all the critical care drugs like our ACLS drugs, like like epi and vasopressin, are usually the cause of this ghost rhythm, keeping that heart ticking. But here are some other causes of PEA. The six H's, so hyperkalemia, known as high potassium, hypoxia, this is our low oxygen, hypothermia, known as low heat, or basically a cold patient, hydrogen ion excess, basically meaning the major acidosis overload in the body, called acidosis, metabolic or respiratory.
Also, hypovolemia, low fluid, and hypoglycemia, low sugar or low glucose. On the other side of the coin, we have the six T's. So, tamponade, like cardiac tamponade, taken from the root word tampon. Cardiac tamponade just basically means the sac around the heart is filled with blood. Tension pneumothorax, meaning the extra area in the thoracic cavity, is putting pressure on the lungs.
Thrombosis, or basically a blood clot, like a... pulmonary embolism or PE, a blood clot in the lungs. Or toxins like medication toxicity. And really a big popular one is digoxin toxicity.
So write that down. And lastly, we have trauma. Now, real quick, take a step back, take a deep breath, and really just critically think, what do all these have in common?
Well, all of them have a decreased cardiac output, that lack of oxygen to the body. always comes up and causes problems. Now signs and symptoms for PEA.
And again, just like asystole, it's very simple. The patient is dead. They'll be unconscious, cold, no pulse, no blood pressure, they'll be not breathing.
So guys, what are we gonna do about it? Well, here are some nursing interventions and treatments. Like all other deadly rhythms, we're gonna call a code, start CPR, intubate the patient, and use our ACLS measures.
Now technically all these things are already done so we're gonna use pharmacology like atropine to increase the heart rate but only if the underlying rhythm is bradycardic less than 60 beats per minute. We'll also use a vasopressin and epinephrine to increase the blood pressure and it does this by vasoconstricting or basically squeezing the blood vessels like toothpaste and all this increases the blood pressure increases that heart rate to increase cardiac output that oxygen to the body. Mainly to the vital organs like the heart and brain. Now the simplest way to remember the main medication for PEA is well just the acronym PEA.
PUSH, EPI, ALWAYS. In 1 mg doses, IV every 3-5 minutes during the arrest. Ok guys now before you ask me in the comments section below, let me read your mind real quick.
You're probably thinking, Mike what about defibrillation? Well here's a question for you. Can you shock PEA?
Can you? Well actually no you cannot, but the real question is why? Well it's not a shockable rhythm because the electrical system in the heart is actually working properly. Shocking the patient is done to reset the heart rhythm and since PEA isn't a conduction problem, this means we can't technically shock it.