PEA is the presence of electrical complexes without accompanying mechanical contraction of the heart ( Fig 24.-35.). In the setting of a cardiac arrest, PEA is due to a profound metabolic abnormality of the myocardium, rendering it noncontractile. At this time, there is no clearly beneficial therapy; the best that can be recommended currently is continued cardiopulmonary resuscitation and a-adrenergic agents. Although calcium has been advocated traditionally, most studies have found no consistent benefit, and there are serious biophysiologic reasons to question the use of calcium in the setting of cardiac arrest. Electrical pacing is, of course, not effective.
Other conditions that may mimic PEA are (1) severe hypovolemia, (2) cardiac tamponade, (3) tension pneumothorax, (4) massive pulmonary embolus, and (5) rupture of the ventricular wall. The first three conditions are potentially treatable if recognized early.
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