Medical Principles and Practice published an article that uses a structured teaching tools to summarized 5 Hs and 5 Ts in PEA cardiac arrest, Lets start with 5 Hs(Hyper and Hypo K, Hypoxia, Hydrogen, Hypovolemia and Hypothermia) and 5 Ts( Tension PTX, Tamponade, Trauma, Toxins, Thrombosis), a very routine practice in ACLS guideline, But this method by Litmann L, et al, seems simplified that approach to a Narrow or Wide complex and I believe this will help us when we are doing CPR to approach better. If You see a Narrow complex PEA on the monitor you should think about mechanical right ventricle issues such as Tamponade. PE, Tension PTX, mechanical hyperinflation, and Acute MI, cardiac rupture. the answer should be Ultrasound and see hyperdynamic LV. The term of pseudo PEA refers to the mechanical causes are not directly related to abnormal myocardial performance. If there is a Wide complex PEA, we should think about Sever Hyper K, Sodium channel blocker Toxicity, and Acute MI,Pump Failure, use of US will let us to know about hypokinetic vs Akinetic cardiac activity. Based on this protocol treatment is easy in Narrow complex we will treat the cause, and based on Wide complex we will give IV calcium chloride and Nahco3.
Medical Principles and Practices