Pulseless Electrical Activity

Courtesy of Wikipedia -Pulseless Electrical Activity or PEA (also known by the older term Electromechanical Dissociation or Non-Perfusing Rhythm) refers to any heart rhythm observed on the electrocardiogram that should be producing a pulse, but is not. The most common cause is hypovolemia.
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.

• Hypovolemia
• Hypoxia
• Hydrogen ions (Acidosis) *****
• Hyperkalemia or Hypokalemia
• Hypoglycemia
• Hypothermia
• Tablets or Toxins (Drug overdose)
• Cardiac Tamponade
• Tension pneumothorax
• Thrombosis (Myocardial infarction)
• Thrombosis (Pulmonary embolism)
• Trauma (Hypovolemia from blood loss)

A patient in their 50’s had been in our ER all day with abdominal pain. The person was finally rushed to surgery after 5 liters of IV fluids, and a levophed drip could not get their blood pressure out of the toilet.
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.