Possible Causes of PEA
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Clues
History of fluid or blood loss
Flat neck veins
No or poor pulse with CPR
Management
Fluid infusion
Control of bleeding sites
Clues
History of trauma, CPR chest pain or viral illness
Distended neck veins
No or poor pulse with CPR
Management
Fluid infusion
Needle decompression- pericardiocentesis
Cardiac tamponade
Pulsus paradoxus
Pericardial friction rub
Enlarged heart on CXR
Echocardiogram:Impairment of ventricular diastolic filling caused by pressure
in pericardial sac
Clues
History of trauma, central lines, CPR or COPD
No or poor pulse with CPR
Respiratory distress
Florid face
Tracheal deviation
Distended neck veins
Tachycardia
Hypotension
Management
Needle decompression
second intercostal space, near the sternum
Fluid infusion
Clues
History of respiratory problems
Difficult ventilation or intubation
Persistent cyanosis
Management
Trouble shoot ventilation
Correctly intubated?
Oxygen connected?
Ventilation volumes adequate?
Clues
History of exposure, drugs, diabetes, alcohol, drowning, sepsis
Cold patient
Management
Rewarm (beware arrhythmia)
Intubate
Avoid unnecessary movements, procedures, etc
Clues
History of DVT, hip fracture, trauma, oral contraceptives
No or poor pulse with CPR
Management
Thrombectomy
Thrombolytics?
Clues
History of renal failure, potassium intake, other drug
Peaked T-wave, wide QRS, or sine wave on ECG
Management
Calcium
Sodium bicarbonate
Glucose and insulin
Clues
History of ingestion, pill bottles, young victim
Management
Drug specific management
Fluids
Epinephrine
Clues
History of renal failure, other acidosis
ABG
Management
Hyperventilation
Sodium bicarbonate
Clues
History of chest pain or MI
ECG
Management
Epinephrine, balloon pump
Consider rupture of myocardial wall with tamponade