Quick question

[medichopeful]

Hi all,

I have a quick question. I heard the other day that PEA can show as normal sinus rhythm on an EKG, with no actual cardiac output. I've done some research, but can anybody lead me towards any information on this? Is there a name for the condition? Is it even possible?

Thanks!
E.

 

[lightsandsirens5]

Sure. Get a torn aorta, bleed out in like 15 seconds and have absolutely zero cardiac output even though you will see nicely organized electrical activity on the EKG. (For a little while at least.)

Strictly speaking, PEA is any pulse-less electrical activity on the EKG that is not V-Fib or pulse-less V-Tach. Sinus rhythm, A-fib, you name it.

That all being said, PEA in and of itself won't last long, cause you gonna have some dead cardiac tissue pretty darn quick.

 

[usafmedic45]

Sure. Get a torn aorta, bleed out in like 15 seconds

One of my favorite autopsy experiences was a tension hemothorax due to an aortic tear. Guy had about 4 liters of blood in his left pleural cavity. And people wonder why I insist on a full faceshield and cap when I observe autopsies for me research.

 

[lightsandsirens5]

One of my favorite autopsy experiences was a tension hemothorax due to an aortic tear. Guy had about 4 liters of blood in his left pleural cavity. And people wonder why I insist on a full faceshield and cap when I observe autopsies for me research.

Holy schnikeys!

 

[usafmedic45]

Hi all,

I have a quick question. I heard the other day that PEA can show as normal sinus rhythm on an EKG, with no actual cardiac output. I've done some research, but can anybody lead me towards any information on this? Is there a name for the condition? Is it even possible?

Thanks!
E.

By the way you can also see this in tension pneumothorax, pericardial tamponade and a few other extra-cardiac causes of arrest. Basically if the cause isn't due to the heart, some of form of toxicity or a lack of oxygen, you can theoretically see a PEA arrest with a sinus rhythm. It will seldom ever be NSR except as it starts to slow down from sinus tach as the heart starts to shutdown.

 

[usafmedic45]

Holy schnikeys!

Something like that. We cut into the chest wall and a two to three foot gush of blood came out. The autopsy tech looked at the pathologist and goes "We're sure he's dead....right?"

 

[Shishkabob]

Is there a name for the condition?

Yup, and you used it, PEA with an underlying rhythm of NSR.

Is it even possible?

Yup, and infact I even have a 12-lead of such a thing that was posted on EMS12lead.com This patient was in PEA the whole time I was capturing my 12-leads.

Typically the body will try and compensate when in PEA by upping the HR, because it notices it's essentially in shock, so you'll often see tachycardia. However, many things can keep it at a NSR rate such as a patient being on beta blockers. However, PEA can also be caused by extra-cardiac events, such as a pneumothorax, in which the heart is unable to have enough room to effectively beat, therefore PEA.

That all being said, PEA in and of itself won't last long, cause you gonna have some dead cardiac tissue pretty darn quick.

Patient above was in PEA for I believe 3 hours.

 

[mycrofft]

Used to be called EMD.

Electro-mechanical dissociation.
Saw one, we were told later his post-mortem showed a history of widespread coronary artery disease but the capper was one big embolus to a major coronary artery. No EKG's done historically. Sort of coronary artery tic tac toe. This was the guy who was a malingerer, then went and died on us anyway after I ALMOST decided to finish my lunch first.

There's (tactilely) "pulseless" and there is (acoustically) "pulseless". I suppose one could also add haemodynamically pulseless, but as of yet we don't insert pressure sensors into the major arteries. I don't understand how anyone could be in PEA (EMD) for any length of time unless somehow some sort of circulation was taking place which was insensible to the rescuers acoustically or tactilely...unless they only palpated, in which case in a horizontal position some circulation might have occurred.

But that's all academic and empiric.

 

[BEorP]

Yup, and you used it, PEA with an underlying rhythm of NSR.

Yup, and infact I even have a 12-lead of such a thing that was posted on EMS12lead.com This patient was in PEA the whole time I was capturing my 12-leads.

Isn't that a junctional, not a sinus rhythm?

 

[Shishkabob]

Gah, snagged the wrong one. First 12-lead was NSR, second and third are the one you see. I didn't re-interpret it, since I did that a year ago, I just copy-pasted. This one was by far the cleanest one, though, and showed all the purty ST segments ^_^



Point stands though, yes, you can have SNR PEA.

 

[mycrofft]

Snarky no?

We had a guy with an irregularly-irregular pulse (ausc and palp), exercise SOB...and the EKG machine showed sinus rhythm.
New type of EMD, called "the machine is replaying its memory" (the prior patient...hopefully the prior pt, and not that the thing had been replaying it for the last month or something). Had to replace the machine.