Question about PEA (pulseless electrical activity)

  1. 0
    Hi everyone; I'm a brand new ICU nurse (brand new nurse period, actually). I have a question and hope it's not too silly...

    I recently witnessed a patient that went into PEA (pulseless electrical activity), and I understand the concept of them appearing to have a rhythm but not having corresponding mechanical activity. My question, though, is that when the patient went into this rhythm, the alarm picked it up as asystole. We went into the room and confirmed there was no heartbeat/pulse, but how did the monitor call it asystole if there was still a rhythm?

    Thank you in advance!
  2. 5 Comments so far...

  3. 2
    I have patients that alarm asystole as they're talking to me! Just because it says asystole doesn't mean they really are. Monitors aren't perfect.

    Even after being called post-code, most patients don't go true asystole until a few minutes pass, usually they linger in an escape rhythm for a while before going totally flatline.

    Either the big guy upstairs was looking out for that patient and triggered the monitor to read asystole, or perhaps your pulse ox/art line wasn't picking up a pulse and called it asystole. Our pulse oximeters and art lines are not linked into the alarms for heart rate, maybe yours are. I just highly doubt the ECG picked up a true asystole.
  4. 0
    Gotcha. Thanks very much for the reply!
  5. 1
    The best way is to go back and look at the history. Maybe they had a pause.
    Always_Learning likes this.
  6. 1
    This was most likely caused by the presumed continuous SpO2 monitoring or Arterial BP monitoring. Newer monitors will correlate the SpO2/ART pulsations with the heart rate. If the pt was in PEA and still had a rhythm but their SpO2/ART monitor was set to alarm under a certain pulse rate (or no pulse rate, as it should) you'll get the asystole alarm. Therefore, if the monitors are configured this way, they will alarm asystole with either electrical standstill or pulsatile standstill.
    Always_Learning likes this.
  7. 0
    Thank you all for your replies; they really helped.


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