You respond to the cardiopulmonary arrest of a 72-year-old woman in the intensive care unit. She has no palpable pulse, but the cardiac monitor shows sinus tachycardia at 124/minute. Breath sounds are symmetric with bag-mask positive-pressure ventilation. What is the best next step in management of this patient?A) Immediate electrical cardioversion
Pulseless electrical activity (PEA) is a common cause of cardiopulmonary arrest in the hospital setting. Etiologies of PEA include hypovolemia, hypoxia, hyperkalemia, severe acidosis, pulmonary embolism, cardiac tamponade, and tension pneumothorax. The loss of cardiac output results from decreased ventricular filling (hypovolemia, pulmonary embolism, cardiac tamponade, or tension pneumothorax) or electromechanical dissociation (hypoxia, hyperkalemia, or severe acidosis). Management of PEA arrest requires rapid establishment of vascular access, airway stabilization, and administration of IV fluids. Physical examination focuses on potential correctable etiologies. Electrical cardioversion will not benefit a patient in sinus rhythm. Similarly, cardiac pacing will not help, since the problem is not associated with severe bradycardia. Sudden pericardial tamponade is uncommon, but, if suspected (proper setting, jugular distension, low-voltage ECG), pericardiocentesis is performed. Rapid saline bolus is more likely to be effective and can be given immediately. If sepsis is suspected, broad-spectrum antibiotics would be appropriate, but antibiotic administration will not affect the immediate outcome of the cardiopulmonary arrest.