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Old 05-21-2012
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EKG PEA + Atrial Fibrillation; What is the next step?

A 45-year-old male is brought to the ER with sudden onset palpitations and chest tightness. His past medical history is significant for hypertension, gout and diabetes mellitus. Cardiac monitoring shows atrial fibrillation at a rate of 120-140/min. As the nurse is attempting to establish IV access, the patient becomes unresponsive. There is no palpable pulse over the carotids or femoral arteries. The cardiac monitor still shows atrial fibrillation at the same rate What is the best next step in management?

A. Synchronized cardioversion
B. Defibrillation
C. IV lidocaine
D. Chest compressions
E. Arterial blood gas analysis
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Old 05-21-2012
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I think A but not sure
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Old 05-21-2012
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A. Synchronized cardioversion
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Hemodynamically unstable with AF.
So synchronized cardioversion.
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Old 05-21-2012
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b...defibrilation
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Old 05-22-2012
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its Cardiac arrest due PEA ----a non shockable rhythm
start cardiac compression, its no possible that the pt lost his pulse from Afeb alone
i will shock if the pt develop sever chest pain or HoTN but NOT if he LOST HIS PULSE
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Old 05-22-2012
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Quote:
Originally Posted by bisho View Post
its Cardiac arrest due PEA ----a non shockable rhythm
start cardiac compression, its no possible that the pt lost his pulse from Afeb alone
i will shock if the pt develop sever chest pain or HoTN but NOT if he LOST HIS PULSE
Please explain more
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Old 05-22-2012
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PEA = NO pulse + whatever ECG finding (normal or abnormal)
mgm of cardiac arrest due to PEA/Asystole is cardiac compression & not cardioversion, u proceed with compression 30;1 (3x) --> Epi and so on

this pt present with Afeb which RVR, if his pulse is palpable in the CAROTID, proceed with regular Afeb mgm (Rate & rythm control)
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Old 05-22-2012
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Quote:
Originally Posted by bisho View Post
PEA = NO pulse + whatever ECG finding (normal or abnormal)
mgm of cardiac arrest due to PEA/Asystole is cardiac compression & not cardioversion, u proceed with compression 30;1 (3x) --> Epi and so on

this pt present with Afeb which RVR, if his pulse is palpable in the CAROTID, proceed with regular Afeb mgm (Rate & rythm control)
sorry but what is RVR ?
and thanks for expln.
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Old 05-22-2012
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Quote:
Originally Posted by tyagee View Post
sorry but what is RVR ?
and thanks for expln.
RVR: rapid ventricular rate

remember the causes of PEA (wiki)
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)
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The above post was thanked by:
rigbbm (05-05-2016), tyagee (05-22-2012), um aala (05-22-2012)



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