PEA (Pulseless Electrical Activity) 일 때 반드시 생각해봐야 할 가역적 원인들 (6H, 6T)
Reference : Oommen 2013, 419; American heart association 2015, 25
6H’s cause PEA
(1) Hypovolemia
- Clue : Carotid weak or disappear
- Management : Volume infusion with a 250ml fluid bolus
(2) Hypoxia
- Clue : Cyanosis, blood gases, airway obstruction
- Management : Mechanical ventilation, capnography monitoring.
(3) Hydrogen ion (acidosis)
- Clue : Renal failure
- Management : Sodium bicarbonate, hyperventilation.
(4) Hyperkalaemia
- Clue : History of renal failure, diabetes, recent dialysis, medication, ECG.
- Management : Calcium chloride; combination of insulin, glucose, sodium bicarbonate.
(5) Hypothermia
- Clue : History of exposure to cold, central body temperature, ECG.
- Management : Gradual warming with fluids and warming blanket.
(6) Hypoglycemia
6T’s cause PEA
(1) Tension pneumothorax
- Clue : Tracheal deviation, no pulse with CPR, history of asthma, ventilator, COPD.
- Management : Chest tube insertion or needle decompression.
(2) Tamponade cardiac
- Clue : Vein distension, no pulse with CPR, impending tamponade- tachycardia, hypotension, low pulse pressure.
- Management : Pericardiocentesis guided by echocardiography.
(3) Toxins
- Clue : Bradycardia, history of ingestion, empty bottles at the scene, pupils, neurologic examination.
- Management : Drug screens, intubation, lavage, activated charcoal, lactulose, antidotes.
(4) Thrombosis, pulmonary
- Clue : History and no pulse felt with CPR
- Management : A pulmonary arteriogram, surgical embolectomy, fibrinolytic.
(5) Thrombosis, coronary
- Clue : History, ECG, enzymes
- Management : Fibrinolytic, percutaneous coronary intervention (PCI)