But if they have a non-shockable rhythm (PEA/Asystole), you prioritize intubation without restoring oxygen, since the heart will stay unshockable until you do. That may require surgery.Īccording to the algorithm, if you have a shockable rhythm, you shock before intubating the patient. These measures are more about buying time so that the cause can be addressed. With that said, since hypoxia accounts for over 50% of PEA, epinephrine and ACLS airway management such as intubation are the emergency procedures stated in the ACLS Cardiac Arrest Algorithm. Surgery to remove the pulmonary embolus.Needle decompression of a collapsed lung.In a hospital setting, this may involve several Advanced Cardiac Life Support Techniques and procedures such as: But you must treat the cause of the PEA arrest to reverse the state and obtain a shockable rhythm. If the PEA arrest is among the H and T, then it may be reversible. Trauma (physical) – A serious bodily injury, e.g., blunt force trauma or penetrating trauma.Thrombosis (myocardial infarction) – Usually a blood clot in the vessels of the heart.Thrombosis (pulmonary embolus) – A blockage, usually a blood clot that gets caught in the lungs. Toxins – These could include sedatives, opioids, pesticides, acid, anaphylactic shock-inducing allergens, sodium-potassium blockers, etc.Tamponade (Cardiac) – Pressure caused by fluid or blood building up in the area outside the heart muscle in the heart sac.Tension pneumothorax – ongoing entry and trapping of air in the pleural area around the lungs.Hypo/Hyperkalemia – Too little / too much potassium in the body.H+ (acidosis) or Metabolic Acidosis, an increase in hydrogenĬoncentration in the body leading to a low serum bicarbonate.Hypovolemia – Loss of blood volume (bleeding out).What Are The Reversible Causes of Cardiac Arrest (H and T)?Įxperts break down the reversible causes of cardiac arrest into two primary categories, conveniently called H and T, or H’s & T’s. Poor contractility, usually caused by acidosis or a reduction in calcium concentration.Increased afterload from something like vascular resistance.Decreased preload from hypovolemia (loss of blood impairing atrial contractions)…This is the second most common cause of PEA.This patient probably needs intubation before shock will have an effect. Unless the oxygen is restored, the heart muscle will die, and death results. With oxygen cut off, the heart no longer has the means with which to contract, even if the heart were otherwise fully capable of a contraction with electrical stimulation from an AED. Hypoxia is one of the most common causes of PEA, leading to an estimated 1/2 of PEA events. It is a latter stage in the dying process that begins with the stopping of another vital organ: the brain, the lungs, or the vascular system for one reason or another. So a PEA arrest is not a primary cardiac arrest. This loss of pulse is the beginning of PEA arrest. The heart continues to pump until it no longer has the oxygen it needs for cardiac functions. In reality, the vascular system should also be considered a vital organ. Without the vascular system, that blood can’t get to other vital organs, so the brain and lungs stop. However, in the case of a PEA arrest, the vascular system has collapsed. If professionals cannot restore this organ, it causes other organ failures. This begins with the loss of function of a vital organ, e.g., brain, heart, or lungs. In order to understand how to save a life during a cardiac arrest, you need to take a look at the dying process. How It Happens: Understanding the Dying Process PEA arrest is most common in women, and the chance of this happening increases for those over 70, particularly among women. This leads to an increased chance of PEA arrest happening, and it is less likely that treatment will be successful. PEA arrests are a surprisingly common occurrence in the hospital setting.Ī study reported in NIH.gov found that 68% of tracked in-hospital deaths and 10% of all in-hospital deaths could be attributed to pulseless electrical activity.Ī PEA arrest is the first documented rhythm in as many as 38% of adults experiencing hospital cardiac arrest (IHCA).Ĭertain medications such as beta-blockers and calcium channel blockers may alter ventricular contractility.
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