These causes are potentially reversible during the out-of-hospital period or shortly after admission in the emergency department (ED), thereby promoting the concept of “reversible causes”. in 1995, is proposed as a reminder to assess for Hypoxia, Hypovolaemia, Hypo-/Hyperkalaemia, Hypothermia, Thrombosis (cardiac or pulmonary), cardiac Tamponade, Toxins, and Tension pneumothorax. The mnemonic “4 (or 5) Hs and Ts”, first described by Kloeck et al. Simultaneously to these measures, identification of potential causes is warranted. Out-of-hospital management of PEA is mainly based on cardiopulmonary resuscitation (CPR) and on early epinephrine administration. Patients suffering out-of-hospital cardiac arrests (OHCAs) presenting initially with PEA have a poor prognosis, with a survival rate to the hospital discharge estimated as between 2%–5%. In past decades, the relative incidence of PEA has regularly increased compared with ventricular fibrillation or pulseless ventricular tachycardia, and is now reported to be between 19%–29%. Some patients present with residual mechanical myocardial contractions, but these are too weak to produce a detectable pulse or blood flow. The absence of mechanical contractions and palpable pulse are due to either the absence of synchronous myocyte depolarisation, vascular failure or alterations of cardiac function. Pulseless electrical activity (PEA) cardiac arrests present with residual organised electrical activity on the electrocardiogram that would normally be associated with a palpable pulse. PEMS: prehospital emergency medical service Introduction ![]() These conditions are potentially accessible to simple diagnostic procedures (computed tomography or echocardiography). Nonischaemic cardiac disorders and intracranial haemorrhage occurred in 8.3% and 6.9%, respectively.ĬONCLUSIONS: Intracranial haemorrhage and nonischaemic cardiac disorders represent significant causes of PEA, with a prevalence equalling or exceeding the frequency of classical 4H&4T aetiologies. Pulmonary embolism, hypovolaemia, intoxication and hypo/hyperkalaemia occurred in fewer than 10% of the cases. We were unable to identify a specific cause in 17.4%. Hypoxia (23.6%), acute coronary syndrome (12.5%) and trauma (12.5%) were the most frequent causes. The mean age was 63.8 ± 20.0 years, 58.3% were men. PEA was the first recorded rhythm in 232 adult patients (12.4%) and 144 of these were admitted to the ED. RESULTS: A total of 1,866 out-of-hospital cardiac arrests were included. All adult patients with PEA as the first recorded rhythm and admitted between 20 to the emergency department (ED) after return of spontaneous circulation or under resuscitation were included. ![]() ![]() ![]() METHODS: This was a retrospective study based on data routinely and prospectively collected. The aim of this study was to analyse the aetiologies of PEA out-of-hospital cardiac arrests and to evaluate their relative frequencies. Other potential aetiologies have been identified, but their respective probability and frequencies are unclear. The mnemonic “4H&4T” was proposed as a reminder to assess for Hypoxia, Hypovolaemia, Hypo/Hyperkalaemia, Hypothermia, Thrombosis, cardiac Tamponade, Toxins, and Tension pneumothorax. PEA is frequently induced by reversible conditions. BACKGROUND:Pulseless electrical activity (PEA) cardiac arrest is characterised by a residual organised electrical activity.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |