![]() What Causes Pulseless Electrical Activity? When these rhythms present on a cardiac monitor they represent the respective rhythm and should be managed as such. Rhythms which are pulseless, such as ventricular fibrillation, pulseless ventricular tachycardia, and asystole, are not associated with PEA.Examples include sinus rhythm, atrial fibrillation, bundle branch blocks, or idioventricular rhythms (a rhythm where you would expect and pulse and there is none). Pulseless electrical activity can present as any organized or partially organized rhythm on an electrocardiogram (ECG). ![]() What Are ECG Characteristics of Pulseless Electrical Activity? ![]() Asystole is considered a separate rhythm than pulseless electrical activity. Rhythms such as ventricular fibrillation and pulseless ventricular tachycardia are not associated with pulseless electrical activity (despite being pulseless) as they tend to respond to defibrillation. During PEA, the heart is unable to move adequate blood volume to maintain systemic perfusion. Pulseless electrical activity is formerly known as electromechanical dissociation (EMD). Pulseless electrical activity (PEA) is defined as the presence of cardiac electrical activity with organized or partially organized cardiac rhythms without a palpable pulse. Sedation should be provided if the patient is conscious as cardioversion is painful.How to Identify and Treat Pulseless Electrical Activity (PEA) Introduction: What is Pulseless Electrical Activity? Lower joules are needed to convert SVTs such as atrioventricular nodal reentrant tachycardia (AVNRT), atrioventricular reentrant tachycardia (AVRT), atrial fibrillation, and atrial flutter. This is simply accomplished by pressing the “sync” button that is found on all defibrillators. The shock that is delivered for SVT is synchronized to occur at a precise time during the “R” wave on the EKG, so as to avoid the vulnerable refractory period which could cause ventricular fibrillation. In this case, synchronized cardioversion, rather than defibrillation, is performed. Patients who are unstable, or who do not respond to medication will require electrical therapy. Patients who are stable may respond well to Vagal Maneuvers to convert them out of the SVT. Patients with an SVT may be relatively stable with few symptoms, or profoundly unstable with severe signs and symptoms related to the rapid heart rate. Patients in a supraventricular tachycardia will have a rapid rhythm with a heart rate greater than 150 beats per minute and a stimulus that originates above the ventricles. Supraventricular tachycardia, or SVT, is far different than the rhythms discussed above, which originate in the ventricles. If it is fine v-fib, you may terminate the rhythm however, if the rhythm is asystole, defibrillation will be ineffective and you can follow the asystole protocol with confidence. If in doubt, it is acceptable to deliver a shock. As the treatments for asystole and ventricular fibrillation are different, it is important to differentiate between the two. Ventricular fibrillation may be fine or coarse coarse ventricular fibrillation is more likely to convert after defibrillation than fine v-fib.įine v-fib is sometimes mistaken for asystole. On the monitor, v-fib will look like a frenetically disorganized wavy line. In this case, the heart quivers ineffectively and no blood is pumped out of the heart. ![]() Ventricular fibrillation (v-fib) is a common cause of out-of-hospital cardiac arrest.
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