Epinephrine should be administered in 1-mg doses intravenously/intraosseously (IV/IO) every 3-5 minutes during pulseless electrical activity (PEA) arrest.
What drug is given first for PEA?
Cardiopulmonary resuscitation (CPR) is the first treatment for PEA, while potential underlying causes are identified and treated. The medication epinephrine (aka adrenaline) may be administered.
What is the most appropriate treatment for PEA?
When treating PEA, epinephrine can be given as soon as possible but its administration should not delay the initiation or continuation of CPR. High-quality CPR should be administered while giving epinephrine, and after the initial dose, epinephrine is given every 3-5 minutes.
Is PEA The first monitored rhythm?
The first monitored rhythm is VF/VT in approximately 25% of cardiac arrests, both in- or out-of-hospital. VF/VT will also occur at some stage during resuscitation in about 25% of cardiac arrests with an initial documented rhythm of asystole or PEA.
What drugs are given for PEA?
Medication Summary
Inotropic, anticholinergic, and alkalinizing agents are used in the treatment of pulseless electrical activity (PEA). As previously stated, resuscitative pharmacology includes epinephrine and atropine.
What is the first step in the PEA algorithm?
ACLS Cardiac Arrest PEA and Asystole Algorithm
- Perform the initial assessment.
- If the patient is in asystole or PEA, this is NOT a shockable rhythm.
- Continue high-quality CPR for 2 minutes (while others are attempting to establish IV or IO access)
- Give epinephrine 1 mg as soon as possible and every 3-5 minutes.
What is the treatment for pulseless electrical activity?
Treatment / Management
The first step in managing pulseless electrical activity is to begin chest compressions according to the advanced cardiac life support (ACLS) protocol followed by administrating epinephrine every 3 to 5 minutes, while simultaneously looking for any reversible causes.
Is atropine used in PEA?
Atropine is inexpensive, easy to administer, and has few side effects and therefore can be considered for asystole or PEA. The recommended dose of atropine for cardiac arrest is 1 mg IV, which can be repeated every 3 to 5 minutes (maximum total of 3 doses or 3 mg) if asystole persists (Class Indeterminate).
What is the preferred priority for drug delivery routes?
Intravenous Route
A peripheral IV is preferred for drug and fluid administration unless central line access is already available. Central line access is not necessary during most resuscitation attempts, as it may cause interruptions in CPR and complications during insertion.
Do you give adrenaline in PEA?
Start cardiopulmonary resuscitation (CPR) with a 30:2 ratio of compressions to rescue breaths for people with pulseless electrical activity (PEA) or asystole. Give adrenaline 1 mg intravenously (IV) as soon as venous access is achieved.
Do you shock a PEA?
Ts. Rhythms that are not amenable to shock include pulseless electrical activity (PEA) and asystole. In these cases, identifying primary causation, performing good CPR, and administering epinephrine are the only tools you have to resuscitate the patient.
What is the difference between pulseless VT and PEA?
Pulseless electrical activity (PEA) and asystole are related cardiac rhythms in that they are both life-threatening and unshockable cardiac rhythms.
Rules for PEA and Asystole.
| PEA Regularity | Any rhythm including a flat line (asystole). |
|---|---|
| Rate | Any rate or no rate. |
| P Wave | Possible P wave or none detectable. |
When do you give atropine?
Atropine is useful for treating symptomatic sinus bradycardia and may be beneficial for any type of AV block at the nodal level. The recommended atropine dose for bradycardia is 0.5 mg IV every 3 to 5 minutes to a maximum total dose of 3 mg.
What are the initial steps of treating asystole PEA?
1. Initial treatment of asystole/PEA is as follows: Continue CPR for 2 minutes.
Check pulse and rhythm every 2 minutes, as follows:
- If nonshockable, see Nonshockable Rhythm (above).
- If shockable, see Shockable Rhythm (above).
- Rotate chest compressors.
- Identify and treat reversible causes.
When is atropine preferred over epinephrine?
Note: If dealing with primary bradycardia (defined above), atropine is preferred as the first-choice treatment of symptomatic AV block. If dealing with secondary bradycardia, atropine is not indicated for the treatment of AV block, and epinephrine should be used.
What drug is given after epinephrine?
Vasopressin should be effective in patients who remain in cardiac arrest after treatment with epinephrine, but there is inadequate data to evaluate the efficacy and safety of vasopressin in these patients (Class Indeterminate).
When do you use adenosine vs atropine?
Atropine is the first-line treatment for symptomatic bradycardia, except for patients with a heart transplant. The first-line treatment for stable patients with supraventricular tachycardia (SVT) is a vagal maneuver. Adenosine is used for narrow complex, regular SVT if vagal maneuvers do not work.
Does atropine work on SA node?
To summarize, atropine may speed the firing rate of the SA node (atria), but the ventricles are not responding to anything the atria (SA node) puts out. Thus, the heart rates will not increase. There may be some action at the AV-node with atropine, but the effect will be negligible and typically not therapeutic.
Why atropine is not given in CPR?
Even though the routine use of atropine for cardiopulmonary arrest has not been recommended since the publication of the 2010 American Heart Association (AHA) Guidelines for CPR and Emergency Cardiovascular Care (ECC), the two selected emergency medical physicians in our emergency center have always routinely used
Which drug route has the fastest action?
The intravenous route is considered to be the fastest route of drug administration. The injections and the infusions are administered by this route have 100% bioavailability.
What drug should never be given IV push?
The most common medications not provided in ready-to-administer syringes include: Antiemetics Antibiotics with short stability Metoprolol Antipsychotics Opioids Furosemide Benzodiazepines Pantoprazole These medications are available in a prefilled syringe, however supply has been limited.
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