Pulseless Electrical Activity (PEA) - Revision history

Jonesk: /* Pharmacologic Therapy: */

2026-03-25T16:19:40Z

Pharmacologic Therapy:

← Older revision		Revision as of 16:19, 25 March 2026
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	====Cases of suspected bradycardia, relative bradycardia or vagally stimulated such as patients found in the restroom.====		====Cases of suspected bradycardia, relative bradycardia or vagally stimulated such as patients found in the restroom.====
	* First, [[Atropine\|ATROPINE]] 0.5 -1.0 mg rapid ~~IVP~~. Repeat every 3 - 5 minutes up to a total of 0.04 mg/kg or approximately 3 mg		* First, [[Atropine\|ATROPINE]] 0.5 -1.0 mg rapid IV / IO. Repeat every 3 - 5 minutes up to a total of 0.04 mg/kg or approximately 3 mg
	* Apply TCP, set at maximum Milliamp. If pulse generated, decrease dosage to setting which still maintains a palpable pulse. If unsuccessful, reattempt capture every 3 - 5 minutes as above		* Apply TCP, set at maximum Milliamp. If pulse generated, decrease dosage to setting which still maintains a palpable pulse. If unsuccessful, reattempt capture every 3 - 5 minutes as above
	* [[Epinephrine\|EPINEPHRINE 1:10,000]] 1 mg IVP or IO Repeat EPINEPHRINE every 3 - 5 minutes of continued arrest		* [[Epinephrine\|EPINEPHRINE 1:10,000]] 1 mg IVP or IO Repeat EPINEPHRINE every 3 - 5 minutes of continued arrest

Treloars at 12:57, 27 June 2023

2023-06-27T12:57:21Z

← Older revision		Revision as of 12:57, 27 June 2023
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	====Pharmacologic Therapy:====		====Pharmacologic Therapy:====
	* [[Epinephrine\|EPINEPHRINE 1:10,000]] 1 mg IV / IO – repeat every 3-5 minutes of arrest		* [[Epinephrine\|EPINEPHRINE 1:10,000]] 1 mg IV / IO – repeat every 3-5 minutes of arrest
	~~'''OR'''~~
	* [[Vasopressin\|VASOPRESSIN]] 40 units IV / IO – to replace the first or second dose of epinephrine
	** Vasopressin is a one-time dose

	{\| class="wikitable"		{\| class="wikitable"

Treloars at 14:43, 24 April 2020

2020-04-24T14:43:11Z

← Older revision		Revision as of 14:43, 24 April 2020
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	* [[Epinephrine\|EPINEPHRINE 1:10,000]] 1 mg IV / IO – repeat every 3-5 minutes of arrest		* [[Epinephrine\|EPINEPHRINE 1:10,000]] 1 mg IV / IO – repeat every 3-5 minutes of arrest
	'''OR'''		'''OR'''
	* [[~~Hormones Vitamins~~\|VASOPRESSIN]] 40 units IV / IO – to replace the first or second dose of epinephrine		* [[Vasopressin\|VASOPRESSIN]] 40 units IV / IO – to replace the first or second dose of epinephrine
	** Vasopressin is a one-time dose		** Vasopressin is a one-time dose

Treloars at 23:38, 23 April 2020

2020-04-23T23:38:10Z

← Older revision		Revision as of 23:38, 23 April 2020
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	====Cases of suspected bradycardia, relative bradycardia or vagally stimulated such as patients found in the restroom.====		====Cases of suspected bradycardia, relative bradycardia or vagally stimulated such as patients found in the restroom.====
	* First, [[~~Antiarrhythmics~~\|ATROPINE]] 0.5 -1.0 mg rapid IVP. Repeat every 3 - 5 minutes up to a total of 0.04 mg/kg or approximately 3 mg		* First, [[Atropine\|ATROPINE]] 0.5 -1.0 mg rapid IVP. Repeat every 3 - 5 minutes up to a total of 0.04 mg/kg or approximately 3 mg
	* Apply TCP, set at maximum Milliamp. If pulse generated, decrease dosage to setting which still maintains a palpable pulse. If unsuccessful, reattempt capture every 3 - 5 minutes as above		* Apply TCP, set at maximum Milliamp. If pulse generated, decrease dosage to setting which still maintains a palpable pulse. If unsuccessful, reattempt capture every 3 - 5 minutes as above
	* [[Epinephrine\|EPINEPHRINE 1:10,000]] 1 mg IVP or IO Repeat EPINEPHRINE every 3 - 5 minutes of continued arrest		* [[Epinephrine\|EPINEPHRINE 1:10,000]] 1 mg IVP or IO Repeat EPINEPHRINE every 3 - 5 minutes of continued arrest

Treloars at 20:02, 22 April 2020

2020-04-22T20:02:26Z

← Older revision		Revision as of 20:02, 22 April 2020
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	====Pharmacologic Therapy:====		====Pharmacologic Therapy:====
	* [[~~Adrenergics~~\|EPINEPHRINE 1:10,000]] 1 mg IV / IO – repeat every 3-5 minutes of arrest		* [[Epinephrine\|EPINEPHRINE 1:10,000]] 1 mg IV / IO – repeat every 3-5 minutes of arrest
	'''OR'''		'''OR'''
	* [[Hormones Vitamins\|VASOPRESSIN]] 40 units IV / IO – to replace the first or second dose of epinephrine		* [[Hormones Vitamins\|VASOPRESSIN]] 40 units IV / IO – to replace the first or second dose of epinephrine
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	* First, [[Antiarrhythmics\|ATROPINE]] 0.5 -1.0 mg rapid IVP. Repeat every 3 - 5 minutes up to a total of 0.04 mg/kg or approximately 3 mg		* First, [[Antiarrhythmics\|ATROPINE]] 0.5 -1.0 mg rapid IVP. Repeat every 3 - 5 minutes up to a total of 0.04 mg/kg or approximately 3 mg
	* Apply TCP, set at maximum Milliamp. If pulse generated, decrease dosage to setting which still maintains a palpable pulse. If unsuccessful, reattempt capture every 3 - 5 minutes as above		* Apply TCP, set at maximum Milliamp. If pulse generated, decrease dosage to setting which still maintains a palpable pulse. If unsuccessful, reattempt capture every 3 - 5 minutes as above
	* [[~~Adrenergics~~\|EPINEPHRINE 1:10,000]] 1 mg IVP or IO Repeat EPINEPHRINE every 3 - 5 minutes of continued arrest		* [[Epinephrine\|EPINEPHRINE 1:10,000]] 1 mg IVP or IO Repeat EPINEPHRINE every 3 - 5 minutes of continued arrest

Treloars at 15:41, 1 February 2018

2018-02-01T15:41:23Z

← Older revision		Revision as of 15:41, 1 February 2018
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	'''''A paramedic may decide to continue resuscitation efforts as outlined in these Practice Parameters. Reasons to continue may include scene safety, location, and input from present family members.'''''		'''''A paramedic may decide to continue resuscitation efforts as outlined in these Practice Parameters. Reasons to continue may include scene safety, location, and input from present family members.'''''

			[[Category:Cardiac\|0404]]

Treloars at 15:03, 26 January 2016

2016-01-26T15:03:24Z

← Older revision		Revision as of 15:03, 26 January 2016
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	'''''If patient combative post resuscitation, refer to [[Analgesia and Sedation\|ANALGESIA /SEDATION PARAMETER (2.04)]].'''''		'''''If patient combative post resuscitation, refer to [[Analgesia and Sedation\|ANALGESIA /SEDATION PARAMETER (2.04)]].'''''


			====Termination of Resuscitation:====
			In Medical Related Cardiac Arrests, the paramedic may terminate resuscitative efforts in Non-Hypothermic Adults provided all of the following criteria have been provided and established:
			* Patient initially presents and maintains PEA
			* Airway has been successfully controlled (not necessarily intubated)
			* If clinically indicated - ATROPINE SULFATE 1.0 mg rapid IVP/ IO has been administered and allowed time to circulate x1.
			* EPINEPHRINE 1:10,000 1 mg IVP or IO has been administered & allowed time to circulate x1, or
			* VASOPRESSIN 40 units IVP has been administered and allowed time to circulate. x1
			* EtCO2 is (less than) < 20 mm Hg
			* Efforts to verify akinetic heart have been taken
			** Lack of Heart sounds
			** Rule out of H's and T's
			'''OR'''
			* After 15 minutes of ALS procedures without any response or return of spontaneous circulation
			'''OR'''
			* After the patient’s personal medical doctor agrees to sign the death certificate
			'''''Contact will be made in conjunction and compliance with Federal, State, Local, and Agency Laws and Policies regarding patient body care and removal.'''''
			<br />

			'''''A paramedic may decide to continue resuscitation efforts as outlined in these Practice Parameters. Reasons to continue may include scene safety, location, and input from present family members.'''''

Treloars at 14:27, 3 May 2012

2012-05-03T14:27:08Z

@@ Line 3: / Line 3: @@
-'''CONSIDER MEDICAL ETIOLOGY OF PEA AND REFER TO APPROPRIATE PRACTICE PARAMETER:'''
+Pulseless Electrical Activity is a condition associated with poor outcomes. It is identified by the presence of cardiac electrical activity with no corresponding mechanical pulse or signs of perfusion. It is important to CONFIRM true PEA early in the management of the case. Consider all possible reversible causes for PEA utilizing a national recommended mnemonic of “H’s and T’s”:
-* Initiate 5 cycles of CPR (30:2) for approximately 2 minutes to allow blood to circulate and continue throughout resuscitation, minimizing interruptions. Assist ventilations with OXYGEN @ 100% via BVM. DO NOT HYPERVENTILATE.
+'''''When the Patient found in True PEA:'''''
-* Consider securing the airway with [[King Tube|KING TUBE]] / [[Intubation Endotracheal|INTUBATION]] and establish IV or IO.
+* Initiate 5 cycles of high quality CPR (push hard/push fast)
-* If hypovolemia suspected, fluid bolus 200 - 300 ml. If time permits.
+** Minimum of 100 compressions per minute, minimize interruptions
-'''If bradycardia, relative bradycardia or vagally stimulated such as patients found in the restroom.'''
+{| class="wikitable"
-* First, [[Antiarrhythmics|ATROPINE SULFATE]] 0.5 -1.0 mg rapid IVP. Repeat every 3 - 5 minutes up to a total of 3 mg.
+|-
-* Apply [[Transcutaneous Pacing Procedure|TCP]], set at maximum Milliamp. If pulse generated, decrease dosage to setting which still maintains a palpable pulse. If unsuccessful, reattempt capture every 3 - 5 minutes as above. Check for pulse and rhythm change after all interventions.
+! The current national guidelines do not include ATROPINE from treatment of TRUE PEA as there is no proof it has a therapeutic benefit. <br />
-* [[Adrenergics|EPINEPHRINE]] 1:10,000 1 mg IVP or IO Repeat [[Adrenergics|EPINEPHRINE]] every 3 - 5 minutes of continued arrest.
+Under the Seminole County Practice Parameters the use of ATROPINE SULFATE is indicated in cardiac arrest that may be caused by extreme bradycardia/hypotension.
-'''
+'''''Check for pulse and rhythm change after all interventions.'''''
-If NO bradycardia or relative bradycardia'''
-* [[Hormones Vitamins|VASOPRESSIN]] 20 units IVP. (Alternate with) [[Adrenergics|EPINEPHRINE]] 1:10,000 1 mg IVP / IO
+====Cases of suspected bradycardia, relative bradycardia or vagally stimulated such as patients found in the restroom.====
-* Repeat for a second dose. Continue [[Adrenergics|EPINEPHRINE]] every 3-5 minutes of arrest.
+* First, [[Antiarrhythmics|ATROPINE]] 0.5 -1.0 mg rapid IVP. Repeat every 3 - 5 minutes up to a total of 0.04 mg/kg or approximately 3 mg
-* Repeat [[Adrenergics|EPINEPHRINE]] every 3 - 5 minutes of continued arrest.
+* Apply TCP, set at maximum Milliamp. If pulse generated, decrease dosage to setting which still maintains a palpable pulse. If unsuccessful, reattempt capture every 3 - 5 minutes as above
-'''If patient combative post resuscitation, refer to [[Analgesia and Sedation|ANALGESIA /SEDATION PARAMETER]] (2.04).'''
+'''''If patient combative post resuscitation, refer to [[Analgesia and Sedation|ANALGESIA /SEDATION PARAMETER (2.04)]].'''''

Treloars: /* 4.04 PULSELESS ELECTRICAL ACTIVITY (PEA) */

2012-04-01T22:36:31Z

4.04 PULSELESS ELECTRICAL ACTIVITY (PEA)

← Older revision		Revision as of 22:36, 1 April 2012
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	* Tension Pneumothorax, [[Chest Injuries\|CHEST INJURIES]] (6.04).		* Tension Pneumothorax, [[Chest Injuries\|CHEST INJURIES]] (6.04).
	* Hypoxia / Acidosis, [[Initial Medical Assessment and Care\|INITIAL MEDICAL CARE]] (2.01).		* Hypoxia / Acidosis, [[Initial Medical Assessment and Care\|INITIAL MEDICAL CARE]] (2.01).
	* Hypothermia, [[~~Environmental~~ Cold Emergencies\|~~ENVIRONMENTAL~~ COLD EMERGENCIES]] (5.06).		* Hypothermia, [[Cold Emergencies\|COLD EMERGENCIES]] (5.06).
	* Hypoglycemia, [[Hypo or Hyperglycemia\|HYPO/HYPERGLYCEMIA]] (5.10)		* Hypoglycemia, [[Hypo or Hyperglycemia\|HYPO/HYPERGLYCEMIA]] (5.10)
	* Toxins, [[Drug Overdose Poisoning\|DRUG OVERDOSE/POISONING]] (5.05)		* Toxins, [[Drug Overdose Poisoning\|DRUG OVERDOSE/POISONING]] (5.05)

Treloars: Created page with "== Section 4 - CARDIAC == === 4.04 PULSELESS ELECTRICAL ACTIVITY (PEA) === '''CONSIDER MEDICAL ETIOLOGY OF PEA AND REFER TO APPROPRIATE PRACTICE PARAMETER:''' * Hypovolemia,..."

2012-02-01T21:19:43Z

Created page with "== Section 4 - CARDIAC == === 4.04 PULSELESS ELECTRICAL ACTIVITY (PEA) === '''CONSIDER MEDICAL ETIOLOGY OF PEA AND REFER TO APPROPRIATE PRACTICE PARAMETER:''' * Hypovolemia,..."

New page

== Section 4 - CARDIAC ==
=== 4.04 PULSELESS ELECTRICAL ACTIVITY (PEA) ===

'''CONSIDER MEDICAL ETIOLOGY OF PEA AND REFER TO APPROPRIATE PRACTICE PARAMETER:'''
* Hypovolemia, [[Shock|SHOCK]] (5.13).
* Tension Pneumothorax, [[Chest Injuries|CHEST INJURIES]] (6.04).
* Hypoxia / Acidosis, [[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] (2.01).
* Hypothermia, [[Environmental Cold Emergencies|ENVIRONMENTAL COLD EMERGENCIES]] (5.06).
* Hypoglycemia, [[Hypo or Hyperglycemia|HYPO/HYPERGLYCEMIA]] (5.10)
* Toxins, [[Drug Overdose Poisoning|DRUG OVERDOSE/POISONING]] (5.05)

* Initiate 5 cycles of CPR (30:2) for approximately 2 minutes to allow blood to circulate and continue throughout resuscitation, minimizing interruptions. Assist ventilations with OXYGEN @ 100% via BVM. DO NOT HYPERVENTILATE.
* Consider securing the airway with [[King Tube|KING TUBE]] / [[Intubation Endotracheal|INTUBATION]] and establish IV or IO.
* If hypovolemia suspected, fluid bolus 200 - 300 ml. If time permits.

'''If bradycardia, relative bradycardia or vagally stimulated such as patients found in the restroom.'''
* First, [[Antiarrhythmics|ATROPINE SULFATE]] 0.5 -1.0 mg rapid IVP. Repeat every 3 - 5 minutes up to a total of 3 mg.
* Apply [[Transcutaneous Pacing Procedure|TCP]], set at maximum Milliamp. If pulse generated, decrease dosage to setting which still maintains a palpable pulse. If unsuccessful, reattempt capture every 3 - 5 minutes as above. Check for pulse and rhythm change after all interventions.
* [[Adrenergics|EPINEPHRINE]] 1:10,000 1 mg IVP or IO Repeat [[Adrenergics|EPINEPHRINE]] every 3 - 5 minutes of continued arrest.

'''
If NO bradycardia or relative bradycardia'''
* [[Hormones Vitamins|VASOPRESSIN]] 20 units IVP. (Alternate with) [[Adrenergics|EPINEPHRINE]] 1:10,000 1 mg IVP / IO
* Repeat for a second dose. Continue [[Adrenergics|EPINEPHRINE]] every 3-5 minutes of arrest.
* Repeat [[Adrenergics|EPINEPHRINE]] every 3 - 5 minutes of continued arrest.

'''If patient combative post resuscitation, refer to [[Analgesia and Sedation|ANALGESIA /SEDATION PARAMETER]] (2.04).'''