PEA vs pulseless v-tach

[Twptophan]

According to ACLS guidelines cardioversion is indicated in the setting of v-fib and pulseless v-tach. I also know that defibrillation is not indicated in PEA. However, isn't pulselss v-tach the same thing as PEA? What makes pulseless v-tach different from PEA with respect to the use of cardioversion? Thanks.

---

Members don't see this ad.

 

[fiznat]

I'll take a stab at this.

The purpose of cardioversion is to reorganize the rhythm. PEA doesn't get cardioverted because it is already as organized as can be. On the other hand, the argument could be made that pulseless VT is pulseless because of an organization issue (too low of a focus, inefficient ventricular contraction, etc). So, it gets cardioverted in the hopes that it will reorganize to a rhythm that produces a pulse.

Hope that helps (and is correct!). Just a paramedic and incoming MS-1, but I've been doing the ACLS thing for a while now..

 

[Rendar5]

pulseless V Tach is technically a form of PEA, but one that can be shocked. Thus it gets its own algorithm.

 

[otacon88]

I think it has to do with the fact that in PEA the heart is not actually physically beating, so you cannot shock it, whereas in pulseless v tach the heart is physically beating, but you just can't get a pulse bc of the tachycardia, so there is something to shock.

 

[mlw47]

If it helps you think of it a different way, PEA used to be called EMD (electromechanical dissociation).

 

[The right Path]

There's also a difference between cardioversion (which is synched with the patient's rhythm) and defibrillation which is not.

 

[Indryd]

I think it has to do with the fact that in PEA the heart is not actually physically beating, so you cannot shock it, whereas in pulseless v tach the heart is physically beating, but you just can't get a pulse bc of the tachycardia, so there is something to shock.

The heart can be beating in PEA. Pulseless electrical activity does not necessarily mean disorganized electrical activity. The heart can be beating regularly even in PEA.

The classic example is with tamponade, for instance from a cardiac effusion or tension pneumothorax. Another classic one is severe hypovolemia. Even an MI that causes ventricular wall dysfunction can leave a patient with organized heart beats, just ineffective ones.

PS Firefox has flagged "tamponade" as misspelled and suggests I substitute "tampon".

 

[ULTRON]

Pulseless V-tach is a disorganized rhythm without a pulse (rate is usually over 180) and PEA is an organized rhythm without a pulse. Cardioversion is only used to reset a disorganized rhythm.

ULTRON

According to ACLS guidelines cardioversion is indicated in the setting of v-fib and pulseless v-tach. I also know that defibrillation is not indicated in PEA. However, isn't pulselss v-tach the same thing as PEA? What makes pulseless v-tach different from PEA with respect to the use of cardioversion? Thanks.

 

[DrDrummer]

This is a really good recent article on thinking about PEA in a useful way:

http://edecmo.org/wp-content/upload...nagement-of-Pulseless-Electrical-Activity.pdf

 

[engineeredout]

Pulseless V-tach is a disorganized rhythm without a pulse (rate is usually over 180) and PEA is an organized rhythm without a pulse. Cardioversion is only used to reset a disorganized rhythm.

ULTRON

So, ULTRON just learned about VTach and PEA from reading his ACLS card, and felt the need to show his knowledge by resurrecting a 4 year old thread. Thanks champ

 

[RustedFox]

If I'm in PEA, and in your ED... please, shock me. Push epi, push lido, push ... whatever. Throw an ultrasound on my heart, and keep at it.

Forget algorithms when it comes down to "fourth and long" time.

Do it all. Maa'an.

 

[RustedFox]

Hell, you can push doxycyclene on me if you think it'll help.

Just do it. Sharpish.