Pulseless CPR

[webby2525]

I was on a call and I'm new and precepting and the medic was telling me four things that can cause a pt not to have a pulse even when CPR is being done properly. Hypovolemia, pericardial tamponade, tension pnuemothorax and pulmonary embolism. I am pretty clear on why the first three would prevent a pulse but I was wondering how a pulmonary embolism would prevent a pulse from being present. I did a search and didn't find anything. Can anyone try to explain this?

[als_medic_uk]

Hello there, you are referring to a massive pulmonary embolism [saddle] that can cause PEA, pathophysiological actions that cause the PEA, are the inotropic states of cardiac muscle and most importantly the sudden changes in preload or after load [cardiac]. You must remember that most PEA's are caused by hypoxia and respiratory failure. A classical mechanical description for PEA due to MPE is decreased preload [inadequate optimal extent], this occurs because the pulmonary embolism causes a 'decreased' venous return from the left atrium, and hence the left ventricle is unable to acquire significant force to cause a contraction. Similar to cardiac tamponade which can have the same effect.

I do apologise if I was too technical, you may want to read some books regarding decreased preload.

Regards

[bandaidpatrol]

Push your epi and atropine (PEA-Problem/Epi/Atropine), if you can't feel a pulse, or see one on the monitor during CPR, best to call it quits. If the blood isn't moving, the brain is dying. What would the chances be they would have the same quality of life?

I probably would have called MedCom to beg permission to cease resuscitative efforts.

[webby2525]

Thank you, i will look into the decreased preload. Bandaid you must have misunderstood me. I am only a basic and the call wasnt an arrest, he just decided he'd test me after the call on some random thing..lol Anyways, thatnks again

[Ridryder 911]

PEA syndrome is more a short circuit. Formerly known as electrical mechanical disassociation, it more where the electrical firing does not cause conduction in the muscle myocardial fibers. It can be caused by many factors, such as describes as well as hypovolemia, pericardial tamponade, electrolyte imbalances, etc...

Be safe,

R/R 911

[als_medic_uk]

Push your epi and atropine (PEA-Problem/Epi/Atropine), if you can't feel a pulse, or see one on the monitor during CPR, best to call it quits. If the blood isn't moving, the brain is dying. What would the chances be they would have the same quality of life?

I probably would have called MedCom to beg permission to cease resuscitative efforts.

What about Sodium Bicarbonate or TCP? I know you have a funeral parlor, are you in need of the money?

Regards.

[WelshMedic]

The causes of PEA - the 4H's and the 4 T's:

Hypoxia

Hypothermia

Hypovolaemia

Hypo/Hyperkalaemia

Tension Pneumothorax

Thrombo-embolic obstruction

Toxicity

Tamponade

Carl.

[als_medic_uk]

The causes of PEA - the 4H's and the 4 T's:

Hypoxia

Hypothermia

Hypovolaemia

Hypo/Hyperkalaemia

Tension Pneumothorax

Thrombo-embolic obstruction

Toxicity

Tamponade

Carl.

The question was not the causes it was the mechanisms [the person knows the causes], and its called the 5 H's and 5T's, not 4.

Regards.

[bandaidpatrol]

What about Sodium Bicarbonate or TCP? I know you have a funeral parlor, are you in need of the money?

Regards.

I was a paramedic for 34 years, and a combat medic on the line for two years. I know how to do my job. I don't feel that you are in a position to judge my career. I did my best working as a medic, a funeral director, a service owner, and watching my best friends die.. So that I could provide for a family of ten, give them a comfortable life, put them through college, two through medical school, and one who followed in the footsteps of the funeral service.

The point of my post, was offering an anecdote to the abbreviation PEA. I didn't go into detail.. If you want to run through every possible protocol that exists for cardiac arrest, weather or not they all use the last resort meds, go ahead. I assume they would already know how to do their job, and I wasn't questioning anyone.

[bandaidpatrol]

The causes of PEA - the 4H's and the 4 T's:

Hypoxia

Hypothermia

Hypovolaemia

Hypo/Hyperkalaemia

Tension Pneumothorax

Thrombo-embolic obstruction

Toxicity

Tamponade

Carl.

Also consider Hydrogen Acidosis and Coronary Thrombosis