The approach in treatment of PEA is to treat the underlying cause. These possible causes are remembered as the 6 Hs and the 6 Ts.
- Hydrogen ions (Acidosis) *****
- Hyperkalemia or Hypokalemia
- Tablets or Toxins (Drug overdose)
- Cardiac Tamponade
- Tension pneumothorax
- Thrombosis (Myocardial infarction)
- Thrombosis (Pulmonary embolism)
- Trauma (Hypovolemia from blood loss)
A large length of gangrenous, dead bowel was discovered during the lengthy surgery. It was removed and a colostomy was made. The patient came to Recovery with much better blood pressure.
Although the patient was on a ventilator, we noticed they were starting to look a little blue. They had a normal looking rhythm on the monitor. However the pulse weakened and then stopped. PEA. Call a code. Start compressions.
It turned out the patient was extremely acidotic*** and ended up getting 4 amps of bicarb in addition to the 2 during surgery that they had gotten. A pulse returned. Not out of the woods for sure, but able to go to ICU at least. I checked when I came in the next evening. The patient was still alive.