PEA, formerly known as electromechanical dissociation, occurs in patients who have organized cardiac electrical activity without a palpable pulse. 13 Furthermore, post-countershock PEA with a slow and wide complex rhythm is associated with a worsened prognosis compared to the rapid, narrow complex PEA. 17,3 In addition, pulseless electrical activity after countershock is correlated with a worse prognosis than PEA presenting as the initial rhythm, with 0% to 2% of patients in post-countershock PEA surviving to discharge. 5,6 PEA arrests are associated with a poor prognosis, with a survival to discharge rate between 2% and 5% for out-of-hospital cardiac arrest. 20,15 For out-of-hospital cardiac arrest, the incidence of PEA is 22% to 30%. Several studies have shown the incidence of PEA in-hospital to be approximately 35% to 40% of arrest events. 16 Two-thirds of OHCA has an initial non-shockable rhythm of PEA or asystole with an increasing incidence compared with initial shockable rhythms (ventricular fibrillation and pulseless ventricular tachycardia). 10 The initial rhythm may be ventricular fibrillation (VF), pulseless ventricular tachycardia (VT), asystole, or pulseless electrical activity (PEA). Sedation should be provided if the patient is conscious as cardioversion is painful.Approximately 300,000 out-of-hospital cardiac arrests (OHCA) occur annually in the United States, with survival around 8%. Lower joules are needed to convert SVTs such as atrioventricular nodal reentrant tachycardia (AVNRT), atrioventricular reentrant tachycardia (AVRT), atrial fibrillation, and atrial flutter. This is simply accomplished by pressing the “sync” button that is found on all defibrillators. The shock that is delivered for SVT is synchronized to occur at a precise time during the “R” wave on the EKG, so as to avoid the vulnerable refractory period which could cause ventricular fibrillation.

In this case, synchronized cardioversion, rather than defibrillation, is performed. Patients who are unstable, or who do not respond to medication will require electrical therapy. Patients who are stable may respond well to Vagal Maneuvers to convert them out of the SVT. Patients with an SVT may be relatively stable with few symptoms, or profoundly unstable with severe signs and symptoms related to the rapid heart rate. Patients in a supraventricular tachycardia will have a rapid rhythm with a heart rate greater than 150 beats per minute and a stimulus that originates above the ventricles. Supraventricular tachycardia, or SVT, is far different than the rhythms discussed above, which originate in the ventricles. If it is fine v-fib, you may terminate the rhythm however, if the rhythm is asystole, defibrillation will be ineffective and you can follow the asystole protocol with confidence. If in doubt, it is acceptable to deliver a shock. As the treatments for asystole and ventricular fibrillation are different, it is important to differentiate between the two.

Ventricular fibrillation may be fine or coarse coarse ventricular fibrillation is more likely to convert after defibrillation than fine v-fib.įine v-fib is sometimes mistaken for asystole. On the monitor, v-fib will look like a frenetically disorganized wavy line. In this case, the heart quivers ineffectively and no blood is pumped out of the heart.

Ventricular fibrillation (v-fib) is a common cause of out-of-hospital cardiac arrest.

Icd 10 pulseless electrical activity