![]() Please remember that this system is an academic proposal and as the author himself writes, there are some limitations, especially with patients with a pre-existing left bundle branch block or a massive PE, where the complexes may appear wide. If Na channel blockade is suspected, give NaHCO3.If Hyperkalaemia is suspected give NaHCO3 and Calcium.If a Tension pneumothorax then decompress.If there is over ventilation, disconnect.The echocardiogram can give the rest of the solution Start Fluid- Normal Saline and be aggressive as these causes may respond to fluid.How To Use This Approach In A Narrow QRS Complex PEA The proposed approach doesn’t specifically use hypothermia or toxins but assumes that given the history of presentation, that these causes will be picked up. This approach doesn’t take into account hyperaemia, hypokalaemia, or hypoglycaemia, however the frequency of progression to PEA of these patients is very rare(4). This is usually due to a metabolic problem or ischaemia and heart failure. In a 2014 paper, Littmann et al(3) proposed a new tool that simplified the approach to PEA by simply looking at the width of the QRS complex and dividing the causes based on QRS width. We now use echocardiography and certainly our appreciation of electrocardiographic tracings has much improved, yet neither ECG tracings nor echocardiography appear anywhere in these protocols. Things have changed since these guidelines were produced. That’s been my approach since I can remember. ….Then I’ve got to think of the others…….Could they be having a PE or MI or is there a cardiac tamponade?.I personally have an approach that is as follows: In fact the literature shows that it is difficult during an arrest to remember them all(2), so you and I are not alone. I don’t know about you but I see people trying to think of them during an arrest and having trouble. When confronted by the PEA patient, ACLS guidelines require us to quickly evaluate the potential cause by citing the H’s and T’s. More on this will follow in the next few blogs. More recently, the term pseudo-PEA, is used for those patients where we can’t find an output by feeling for a pulse, but there may in fact be one, when we view the heart by echocardiography. Given that it’s not a shockable rhythm, it has a very poor prognosis, especially when associated with acute myocardial Infarction(MI)(1). No commercial use is permitted unless otherwise expressly granted.Pulseless Electrical Activity(PEA) occurs in about 30% of cardiac arrest cases. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2019. Sixteen (30%) piglets remained bradycardic (defined as HR of <100/min) after 10 min of asphyxia, identified by CBF, ECG and auscultation.Ĭlinicians should be aware of the potential inaccuracy of ECG assessment during asphyxia in newborn infants and should rather rely on assessment using a combination of auscultation, palpation, pulse oximetry and ECG.Īuscultation electrocardiography heart rate neonatal resuscitation newborn. In 23 (43%) piglets, we observed no CBF and no audible heart sounds, while ECG displayed an HR ranging from 15 to 80/min. In 14 (26%) piglets, CBF, ECG and auscultation identified asystole. Overall, 54 piglets were studied with a median (IQR) duration of asphyxia of 325 (200-491) s. Asystole was defined as zero carotid blood flow and was compared with ECG traces and auscultation for heart sounds using a neonatal/infant stethoscope. The piglets were exposed to 30 min normocapnic alveolar hypoxia followed by asphyxia until asystole, achieved by disconnecting the ventilator and clamping the endotracheal tube. This set-up allowed simultaneous monitoring of HR via ECG and carotid blood flow (CBF). Neonatal piglets had the right common carotid artery exposed and enclosed with a real-time ultrasonic flow probe and HR was continuously measured and recorded using ECG. To compare accuracy of ECG with auscultation to assess asystole in asphyxiated piglets. However, a recent case report raised concerns about this technique in the delivery room. ![]() The 2015 neonatal resuscitation guidelines added ECG as a recommended method of assessment of an infant's heart rate (HR) when determining the need for resuscitation at birth. ![]()
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