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EMD Cardiac Arrest 22/10/10 SP Notes DEFINITION PEA = presence of coordinated electrical activity in myocardium but no detectable cardiac output - prognosis far less favourable than VF/VT - treat cause CAUSES Hypovolaemia Hypoxia Hyper/hypokalaemia and metabolic disorders Hyper/hypothermia Toxicity Tension pneumothorax Tamponade (cardiac) Thromboembolism – MI or PE MANAGEMENT ACLS protocol Supportive care: continuous CPR, intubation + ventilation, IV access, adrenaline 1mg Q3 min Specific therapy to treat cause: Hypovolaemia – fluid, blood products, stop bleeding, clamp vessels Hypoxia – intubation and ventilation (FiO2 1.0) Hypokalaemia – K+ replacement Hyperkalaemia – treat cause, Ca2+ gluconate 10mL 10%, insulin-dextrose, salbutamol, NaHCO3 Metabolic disorders – Mg2+ if low, Ca2+ if low, acidosis -> HCO3 Hyperthermia – cool, dantrolene for MH Hypothermia– warm Toxicity – stop absorption, increase elimination, antidote to specific drug Tension pneumothorax – decompress (needle thoracostomy -> ICC) Tamponade – pericardiocentesis, open chest Thromboembolism – thrombolysis (proven or suspected PE) +/- surgical embolectomy Jeremy Fernando (2011)