Pulseless Electrical Activity (PEA)

[RainDreamer, BSN, RN]

Have any of you ever seen this in the NICU?

I'm not at all familiar with it, I vaguely remember hearing about it in nursing school, but that's it.

We just had a kid that this happened to ...... through the whole code I'm just standing there like "what the heck is going on?!" (kid has no HR when you listen, yet the monitor is showing a NSR of 140 bpm)

One of the scariest things I've seen

[sirI, MSN, APRN, NP]

What was the cause of the infant's PEA, Rainy??

[RainDreamer, BSN, RN]

What was the cause of the infant's PEA, Rainy??

I don't know. This was a baby that came over right after birth in SVTs .... with HRs in the 260s+.

[lorilou22RN]

I know nothing about kiddos, but when a pt has PEA ACLS guidelines are to review causes the 5-H's, and the 5-T's. Hypovolemia, hypoxia, hydrogen ion, hyper-hypokalemia, hypothermia or Tablets, Tamponade, Tension pneumo, Thrombosis either cardiac or pulm. Was mom a drugger?

[RainDreamer, BSN, RN]

I know nothing about kiddos, but when a pt has PEA ACLS guidelines are to review causes the 5-H's, and the 5-T's. Hypovolemia, hypoxia, hydrogen ion, hyper-hypokalemia, hypothermia or Tablets, Tamponade, Tension pneumo, Thrombosis either cardiac or pulm. Was mom a drugger?

I've never taken ACLS, just the brief little bit we got in nursing school. I was curious to see if anyone had ever had experience with this happening in the NICU, as everyone was kinda blown away by it. Good thing the neo knew exactly what was going on and what to do.

Mom was totally clean. But they did have the baby on adenosine for the SVTs.

[sirI, MSN, APRN, NP]

Would be interesting to know final dx.

I cannot remember a neonate with PEA. Sure it happens (obviously it does).

[EricJRN, MSN, RN]

Supposed to very, very rare in neonates. I've never seen one in the NICU, but it's much more common in other age groups. As Lorilou22RN says, identifying an underlying cause is your goal. Otherwise, survival rates tend to be pretty dismal. It is treated along the same algorithm as asystole.

[dawngloves, BSN, RN]

I've only seen it with withdrawl of care pts in the NICU.

Adults it could be hypocalcemia, hypokalemia, I think I saw it with a digoxin overdose once.

[SteveNNP, MSN, NP]

I saw it once on my patient who was circling the drain from serratia sepsis/DIC. I went to his bedside because he was desatting, when I noticed his art line waveform (previously great) was flatlined, with a EKG HR in the 120s. We coded him for 30 minutes, used a lot of bicarb and calcium, if I remember correctly. He was my first patient death as a nurse.

[RainDreamer, BSN, RN]

That's exactly what happened with this kiddo ..... the art line clued us in. His pressures to start with were fine, then all of a sudden they were like 23/21 ..... 19/17.

Afterwards the neo was explaining that anytime you have a sudden drop in sats and you have a narrow pulse pressure, time to listen for a HR and think of PEA.

Like I said, I've never seen this before. Kinda interesting to read about. But scary!

[seanpdent, ADN, BSN, MSN, APRN, NP]

I have no experience with neonates... but had a PEA a couple weeks ago.

She had a pacer.... man was it interesting.

And she survived and moved out of our ICU to a rehab center.

[o1les]

We lost a baby a while ago that went into PEA. Chronic gastroschisis kiddo that was having some emesis/feeding issues. Long story short...Nec. It hit her really fast...KUB's didn't show anything...they thought she was just being a gut kid. Obviously she was fussy... was put in a swing and finally calmed down. The monitor never alarmed. Feeding time came and when the nurse went to check on her she was gone. Long horrible code. It was very scary to think something like that can happen. It really makes me never want to put a fussy kid in a swing, dim the lights, and go chat with my roommate till the next feed.