3. Clinical presentation of pulseless electrical activity (pg. 98 and pg. 241) Presence of electrical activity without mechanical activity (contractility); patient has an ECG reading but has NO PULSE If no pulse is detected, CPR is begun unless there is a ?DNR? order for the patient For the best chance of survival, the cause of the pulseless electrical activity should be identified and treated. Common causes include: hypovolemia, hypoxemia, electrolyte imbalances, hypothermia, tension pneumothorax, cardiac tamponade, massive MI, drug overdose, acidosis, trauma, hypoglycemia, pulmonary emboli Critical actions for patient with pulseless electrical activity: 1. initiate CPR for 5 cycles or 2 minutes, intubate, and obtain IV access 2. Consider possible causes 3. Confirm asystole by ensuring lead and cable connections are correct, power is on, and verifying asystole in another lead 4. Check rhythm for no longer than 10 seconds. If recognized electrical activity is present, palpate a pulse for at least 5 seconds but no longer than 10 seconds. If no pulse is present, resume CPR for 5 cycles or 2 minutes 5. Administer epinephrine during CPR (1 mg IV push every 3-5 minutes) or vasopressin (40 units IV) to replace the first or second dose of epinephrine. Do not stop CPR during drug administration. May consider atropine (1 mg IV every 3-5 minutes) for asystole or slow PEA rate 6. Resume CPR for 5 cycles or 2 minutes; check rhythm and pulse 7. Continue ABCDs 8. Consider termination of resuscitation if a reversible cause is not rapidly identified and the patient fails to response to the BLS primary survey and ACLS secondary survey 4. What the QRS represents Ventricular depolarization (contraction) Q wave: Abnormal = greater than 0.04 seconds in width and measuring more than one fourth of the R wave amplitude (known as a pathological Q wave or a significant Q wave) Pathological Q waves are found on ECGs of patients who have had myocardial infarctions; the deep Q wave in these patients indicates an area of myocardial tissue that has died
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