Pulseless Electric Activity

Pulseless Electric Activity

Forget ACLS Guidelines when dealing with PEA

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ALS guidelines are wrong about PEA/asystolecardiac standstill, EMD and Pseudo-PEA are different conditionscentral pulse palpation is not a reliable instrument to screen between those conditionsEkg, EtCO2 and POCUS are all easy to use and reliable diagnostic tools in patients with PEATake home points from part 1

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Take home points from part 1 clinical practiceWhen you are managing a patient in CA and he shows an organized electrical activity, but not a palpable carotid pulseObtain as soon as possible the EtCO2 to evaluate tissue perfusion and cardiac contractilityPerform a 12 lead EKGPerform a systematic diagnostic approach with ultrasound to identify cardiac activity and reversible causes

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Classic classification of causes pea

5 Hs and 5 Ts are bad mnemonics!

Suggested alternative pathophysiologic evaluation of PEA Simplifying the diagnosis and management of pulseless electrical activity in adults: A qualitative review.Norman A. Desbiens, MD Crit. Care Med 2008 Vol. 36, No. 2

Suggested alternative pathophysiologic evaluation of PEA

A Simplified and Structured Teaching Tool for the Evaluation and Management of Pulseless Electrical ActivityLaszlo Littmann a Devin J. Bustin b Michael W. Haley a, cMed Princ Pract 2014;23:16 DOI: 10.1159/000354195

Suggested alternative management of PEA A Simplified and Structured Teaching Tool for the Evaluation and Management of Pulseless Electrical ActivityLaszlo Littmann a Devin J. Bustin b Michael W. Haley a, cMed Princ Pract 2014;23:16 DOI: 10.1159/000354195

Suggested alternative management of PEA

A Simplified and Structured Teaching Tool for the Evaluation and Management of Pulseless Electrical ActivityLaszlo Littmann a Devin J. Bustin b Michael W. Haley a, cMed Princ Pract 2014;23:16 DOI: 10.1159/000354195

Bottom lineWe need different classification for PEA based on pathophysiology and clinical evaluation We need different management approach that is reliable for application in emergency medical situations

Bottom line