A 45 yo male is brought to ER with sudden onset of palpitati

[madhurima]

A 45 yo male is brought to ER with sudden onset of palpitation and chest tightness. His past medical history is signicant for HTN, gout and DM. Cardiac monitoring shows atrial fibrillation at a rate of 120-140/min. As the nurse is attempting to establish IV access, the patient becomes unresponsive. There is no palpable pulse over the carotids or femoral arteries. The cardiac monitor still shows Atrial fibrillation at the same rate. What is the best next step in management?

a. Synchronized cardioversrion

b. Defibrilation

c. IV lidocaine

d. Chest compression

e. Arterial blood gas analysis

[madhurima]

The answer is D.

Pulseless electrical activity is defined as presence of discernible rythm on cardiac monitoring in a patient who is clinically in cardiac arrest with no palpable pulses. Any patient in cardiac arrest with non-shockable rythm( anything other than VF or VT) should immediately receive CPR including manual chest compression establishing definitive airway and ventilation with 100% O2. IV access should also be established. So, ACLs medication that such as epinephrine, vasopressine and atropine can be administered. It is important to make diagnosis of PEA, as there are a variety of treatable causes ( 6 Hs and 6 Ts)

Hs: Hypovolumia, hypoxia, hydrogen ions(acidosis), hypothermia, hypoglycemia, Hypo/Hyperkalemia

Ts: Tamponade(cardiac), tension pneumothorax, thrombosis (MI, PE), trauma (hypvolumic), tablets(drugs) and toxin.

Synchronize cardioversion(A) may be used to convert patient with perfusing tachyarrythmia who are experiencing s/s of serious hemodynamic compromise. Candidate rythms include SVT due to rentry, atrial fibrillation, atrial flutter, and monomorphic Ventricular tachycardia.

Defibrillation for v tach, v fib.