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Pulseless Electrical Activity

(PEA)
History Signs and Symptoms Differential
Past medical history Pulseless Hypovolemia (Trauma, AAA, other)
Medications Apneic Cardiac tamponade
Events leading to arrest Electrical activity on ECG Hypothermia
End stage renal disease No heart tones on auscultation Drug overdose (Tricyclics,
Estimated downtime Digitalis, Beta blockers, Calcium
Suspected hypothermia channel blockers)
Suspected overdose Massive myocardial infarction
Tricyclics Hypoxia
Digitalis Tension pneumothorax
Beta blockers Pulmonary embolus
Calcium channel blockers Acidosis
DNR, MOST, of Living Will Hyperkalemia

AT ANY TIME Cardiac Arrest Protocol Legend


MR
Return of P Cardiac Monitor P
Spontaneous Circulation
B EMT B
CPR
Airway Protocol I EMT- I I
I IV Protocol I P EMT- P P
Go to M Medical Control M
Post Resuscitation Epinephrine
Protocol I or I
Vasopressin
P Atropine if rate <60 P

Medical Protocols
Consider early in all PEA pts:
Normal Saline Bolus
Dextrose 50%
I Naloxone I
Glucagon (suspected
Beta Blocker Overdose)
Calcium (hyperkalemia)
Bicarbonate (tricyclic
overdose, hyperkalemia,
P P
renal failure)
Dopamine
Chest decompression

Stop
Criteria for Discontinuation Yes
resuscitation
No

Notify Destination or Consider


M M P P
Contact Medical Control Epinephrine Drip

Pearls
Recommended Exam: Mental Status
Consider each possible cause listed in the differential: Survival is based on identifying and correcting the cause!
Discussion with Medical Control can be a valuable tool in developing a differential diagnosis and identifying possible
treatment options.
Protocol 29 2009
Any local EMS System changes to this document must follow the NC OEMS Protocol Change Policy and be approved by OEMS

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