# Pacing PEA



## emtkrak (Jan 5, 2008)

One of our crews had a code last week.  A medic on scene asked another medic if he wanted to try to pace a PEA, rate was around 60.  This sparked a huge debate of why you would, why you wouldnt.  I'm a really new medic, and we really didn't touch base on it, I just know I probably wouldnt...

There are two rationales I have heard as to why you should try.  1)  The asystole protocol used to say you could try TCP.  Asystole and PEA are treated the same (aside from atropine in rates over 60) so why wouldnt you pace PEA if you can try pacing asystole.  The 2nd rationale is that there is electrical activity present, with no mechanical capture.  So if you give just enough additional "juice" it may be enough to cause capture.  

Any thoughts?


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## Ridryder911 (Jan 5, 2008)

There is no reason to pace PEA. Now, let's review what PEA is really. It is an electrical mechanical disassociation between pacer site and the receptor of the myocardial muscle fibers. It is not that there is not an electrical impulse already (what TCP provide). Remember, PEA is not a rhythm but a syndrome/condition of. 

What good would there be by providing more electrical stimulus? Again that it is not the problem, it is at the junction and synapse of the muscle fibers increasing power is not going to change the synapse. (refer back to A & P threshold levels of stimuli, etc). The etiology needs to be investigated such as acidosis, hyperkalemia, hypoxia, hypovolemia (not enough RBC to carry oxygen) or even pericardial tamponade, and so on. 

Instead of debate to pace, debate to determine the cause should be have been emphasized. 

The only time I would even consider pacing is a bradycardiac rhythm then it would be a last ditch effort, after Atropine and again looking for the etiology. 

R/r 911


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## Flight-LP (Jan 5, 2008)

There is no sound evidence to support TCP with a pt. in a PEA rhythm. You already have the electrical activity, adding more will NOT help. In fact, if the PEA rate is not bradycardic, you are likely to inflict further issues by adding unecessary electricity. You need mechanical activity, good CPR and Vasopressive agents. Simply comparing similarities between the two based on similar treatments shows a lack of correlation and an ability to truely understand what the heart is doing during an arrest. You gotta know whats goin' on inside!


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## sksmedic (Mar 1, 2008)

I agree. Assessment is 90% of medicine, lets look for a cause.


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## firecoins (Mar 1, 2008)

There isn't a pacing problem to fix.


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## MedicDoug (Mar 1, 2008)

See all the above, plus the AHA ACLS PEA algorithm. The emphasis is on finding the reversible cause, if possible.


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## mikie (Mar 1, 2008)

I'm not an ALS provider, so I'm uneducated in this area, but was curious to know how PEA is commonly treated (other than CPR of course) and the pt. outcomes.

Thanks.

(This sparked a question becuase we recently had a pt. who showed PEA then asystole (and you can guess where it went from there...)).


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## firecoins (Mar 1, 2008)

PEA is caused by a variety of issues like hupovolemia from a trauma.  Fluids would be the treatment, at least pre hospital.  I know other will know more.


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## MSDeltaFlt (Mar 1, 2008)

http://www.acls.net/acls2005/diffdx.htm

Found this.  Should help out.


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## fma08 (Mar 13, 2008)

emtkrak said:


> One of our crews had a code last week.  A medic on scene asked another medic if he wanted to try to pace a PEA, rate was around 60.  This sparked a huge debate of why you would, why you wouldnt.  I'm a really new medic, and we really didn't touch base on it, I just know I probably wouldnt...
> 
> There are two rationales I have heard as to why you should try.  1)  The asystole protocol used to say you could try TCP.  Asystole and PEA are treated the same (aside from atropine in rates over 60) so why wouldnt you pace PEA if you can try pacing asystole.  The 2nd rationale is that there is electrical activity present, with no mechanical capture.  So if you give just enough additional "juice" it may be enough to cause capture.
> 
> Any thoughts?


PEA= the electrical system is workin but the mechanical system isn't. Thus there is a reason for it. Fixing you're H's and T's is the best thing you can do for it... plus Epi, but like they say, give enough Epi and you can bring anyone back. The trouble is keeping it that way, so if you don't fix the underlying problem, PEA will remain PEA and go to Asystole eventually.


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