On arrival, she is placed on monitor and the following rhythm is seen:
You cannot palpate a pulse.
You have performed round of CPR.
Epinephrine is essentially the only medication indicated in PEA arrest.
Amiodarone is useful in vfib/pulsesless vtach but does not have proven role in PEA arrest. Vasopressin was previously indicated if multiple epinephrine doses were unsuccessful. However, most recent updated guidelines call only for epinephrine for PEA arrest.
When evaluating someone in arrest, it is important to consider the “Hs and Ts” during resuscitation as therapies for these causes can treat the arrest. Hs: Hypoxia, Hyperkalemia, Hydrogen ion (acidosis), Hypothermia, Hypovolemia; Ts: Thrombus (MI or PE), Toxins, Tamponade, Trauma, Tension pneumothorax
She now has a palpable pulse but is hypotensive, unresponsive, and hypoxic.
The patient has ventricular tachycardia with a pulse. Defbrillating someone with a pulse is life threatening. Defibrillation delivers electricity immediately whereas during cardioversion, avoids the vulnerable portion of repolarization and safely delivers a shock to convert to normal sinus.
You re-assess the patient and cannot palpate a pulse.
Once the rhythm is identified as vfib or pulses vtach, it is imperative to defibrillate as soon as possible to increase chances of survival.
