Pulseless trauma victim

Pulseless trauma victim

Learning Objectives:

1. Describe the primary A-B-C-D survey.

2. Describe the secondary A-B-C-D survey.

3. Define PEA.

4. Describe the differential diagnosis of PEA.

5. Describe generalized treatment for PEA while searching for a treatable cause.

Primary A-B-C-D Survey:

A. Airway - open airway, assess breathing.

B. Breathing - give two breaths.

C. Circulation - assess circulation, if absent start chest compressions.

D. Defibrillation - attach AED or monitor/defibrillator when available.

Secondary A-B-C-D Survey:

A. Airway - assess and manage - place an endotracheal tube.

B. Breathing - assess and manage - positive pressure ventilation with supplemental oxygen.

C. Circulation - assess and manage - start an IV, administer medications.

D. Differential Diagnosis - assess and manage - search for and treat reversible causes of the arrhythmia.

Definition of PEA:

1. PEA - Pulseless Electrical Activity

2. Absence of a detectable pulse with electrical activity other than ventricular tachycardia or ventricular fibrillation.

3. EMD - electromechanical dissociation - organized electrical depolarization without shortening of myocardial fibers. EMD is a subset of PEA.

Differential Diagnosis of PEA:

PEA is often associated with several reversible clinical conditions. Identify the cause early and provide specific treatment.

5 H's and 5 T's:

Hypovolemia Tablets (drugs)

Hypoxia Tamponade-cardiac

Hydrogen ion-acidosis Tension pneumothorax

Hyper/hypokalemia Thrombosis-coronary

Hypothermia Thrombosis-pulmonary

Generalized Treament of PEA:

1. Airway - secure a patent airway

2. Breathing - ensure ventilation with oxygen but avoid hyperventilation.

3. Circulation - administer vigorous chest compressions.

4. Criculation - obtain IV access and administer fluid boluses if potentially hypovolemic.

5. Circulation - administer epinephrine as a vasopressor to improve coronary perfusion.

6. Search for and treat the cause of PEA.