WordNet

(of a situation) exceptionally tense; "an atmosphere electric with suspicion"
a car that is powered by electricity (同)electric automobile, electric car
using or providing or producing or transmitting or operated by electricity; "electric current"; "electric wiring"; "electrical appliances"; "an electrical storm" (同)electrical
affected by emotion as if by electricity; thrilling; "gave an electric reading of the play"; "the new leader had a galvanic effect on morale" (同)galvanic, galvanizing, galvanising
any specific behavior; "they avoided all recreational activity"
(chemistry) the capacity of a substance to take part in a chemical reaction; "catalytic activity"
relating to or concerned with electricity; "an electrical engineer"; "electrical and mechanical engineering industries"

PrepTutorEJDIC

《名詞の前にのみ用いて》『電気の』;電気が引き起こす / 《名詞の前にのみ用いて》電気で動く,電動の;電気を起こす,発電の / 興奮させる,はらはら(ぞくぞく)させる
〈U〉『活動』,働き;活力 / 《しばしば複数形で》(種々の)『活動』,行事;(学生の)学内(外)活動,クラブ活動 / 〈U〉(商況・市場などの)活発,活気
電気と関係のある / 電気を扱う

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/02/21 01:19:51」(JST)

wiki en

Pulseless electrical activity or PEA (also known by the older term electromechanical dissociation) refers to a cardiac arrest situation in which a heart rhythm is observed on the electrocardiogram that should be producing a pulse, but is not. Under normal circumstances, electrical activation of muscle cells precedes mechanical contraction of the heart (known as electromechanical coupling). In PEA, there is electrical activity, but the heart either does not contract or there are other reasons why this results in an insufficient cardiac output to generate a pulse and supply blood to the organs.^[1]

Cardiopulmonary resuscitation (CPR) is the first treatment for PEA, while potential underlying causes are identified and treated. Various drugs may be administered.^[1]

Signs and symptoms[edit]

Pulseless electrical activity leads to a loss of cardiac output, and the blood supply to the brain is interrupted. As a result, PEA is usually noticed when a person loses consciousness and stops breathing spontaneously. This is confirmed by examining the airway for obstruction, observing the chest for respiratory movement, and feeling the pulse (usually at the carotid artery) for a period of 10 seconds.^[1]

Causes[edit]

These possible causes are remembered as the 6 Hs and the 6 Ts.^[2]^[3]^[4]

Hypovolemia
Hypoxia
Hydrogen ions (Acidosis)
Hyperkalemia or Hypokalemia
Hypoglycemia
Hypothermia
Tablets or Toxins (Drug overdose)
Cardiac Tamponade
Tension pneumothorax
Thrombosis (Myocardial infarction)(Pulmonary embolism)
Tachycardia
Trauma (Hypovolemia from blood loss)

Diagnosis[edit]

The absence of a pulse confirms cardiac arrest, but PEA can only be distinguished from other causes of cardiac arrest with a device capable of electrocardiography (ECG/EKG). In PEA, there is electrical activity in the heart (as opposed to asystole), but not compatible with either ventricular fibrillation or ventricular tachycardia.^[1]

Treatment[edit]

Cardiopulmonary resuscitation should be initiated promptly to maintain cardiac output until the PEA can be corrected. The approach in treatment of PEA is to treat the underlying cause, if known (e.g. relieving a tension pneumothorax). Where an underlying cause for PEA cannot be determined and/or reversed, the treatment of pulseless electrical activity is similar to that for asystole.^[1]

An intravenous or intraosseous line should be started to provide medications through. The mainstay of drug therapy for PEA is epinephrine 1 mg every 3–5 minutes. Although previously the use of atropine was recommended in the treatment of PEA/asystole, this recommendation was withdrawn in 2010 by the American Heart Association due to lack of evidence for therapeutic benefit.^[1]

Sodium bicarbonate 1meq per kilogram may be considered in this rhythm as well, although there is little evidence to support this practice. Its routine use is not recommended for patients in this context, except in special situations (e.g. preexisting metabolic acidosis, hyperkalemia, tricyclic antidepressant overdose).^[1]

All of these drugs should be administered along with appropriate CPR techniques. Defibrillators cannot be used to correct this rhythm, as the problem lies in the response of the myocardial tissue to electrical impulses.^{[citation needed]}

References[edit]

^ ^a ^b ^c ^d ^e ^f ^g 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care (November 2010). "Part 8: Adult Advanced Cardiovascular Life Support". Circulation 122 (18 Suppl): S729–S767. doi:10.1161/CIRCULATIONAHA.110.970988. PMID 20956224.
^ Mazur, Glen (2003). Acls: Principles And Practice. [Dallas, TX]: Amer Heart Assn. pp. 71–87. ISBN 0-87493-341-2.
^ Barnes, Thomas Garden; Cummins, Richard O.; Field, John; Hazinski, Mary Fran (2003). ACLS for experienced providers. [Dallas, TX]: American Heart Association. pp. 3–5. ISBN 0-87493-424-9.
^ 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care (December 2005). "Part 7.2: Management of Cardiac Arrest". Circulation 112 (24 Suppl): IV 58–66. doi:10.1161/CIRCULATIONAHA.105.166557.

UpToDate Contents

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1. 成人における二次救命処置（ACLS） advanced cardiac life support acls in adults
2. 突然の心停止の病態生理および病因 pathophysiology and etiology of sudden cardiac arrest
3. 突然の心停止を呈した成人に対する二次救命処置を支持するデータ supportive data for advanced cardiac life support in adults with sudden cardiac arrest
4. 突然の心停止の転帰 outcome of sudden cardiac arrest
5. 小児に対する二次救命処置ガイドライン guidelines for pediatric advanced life support

English Journal

Therapeutic Hypothermia After Exsanguination.

McGrane S, Maziad J, Netterville JL, Saied NN.SourceFrom the Departments of *Anesthesiology and Critical Care, and.
Anesthesia and analgesia.Anesth Analg.2012 May 14. [Epub ahead of print]
Therapeutic hypothermia has been shown to be effective in out-of-hospital cardiac arrest, and use of this therapy has been expanded to involve in-hospital cardiac arrest. The utility of hypothermia in cardiac arrest after hemorrhage is not known. We describe a case of successful neurological and fun
PMID 22584547

A Low Tilt Waveform in the Transthoracic Defibrillation of Ventricular Arrhythmias during Cardiac Arrest.

Darragh K, Manoharan G, Dimaio R, Stevenson M, Bennett J, Walsh S, Allen J, Anderson J, Adgey A.SourceThe Heart Centre, Royal Victoria Hospital, Belfast N.Ireland; Queen's University, Belfast N.Ireland.
Resuscitation.Resuscitation.2012 May 8. [Epub ahead of print]
AIMS: Most commercially available defibrillators utilise a high tilt waveform. Work in atrial fibrillation has shown improved defibrillation success using low tilt waveforms. We hypothesise that a novel low tilt biphasic waveform will be non-inferior to a standard tilt waveform whilst delivering low
PMID 22579679

Japanese Journal

Impact of Therapeutic Hypothermia in the Treatment of Patients With Out-of-Hospital Cardiac Arrest From the J-PULSE-HYPO Study Registry

Yokoyama Hiroyuki,Nagao Ken,Hase Mamoru,Tahara Yoshio,Hazui Hiroshi,Arimoto Hideki,Kashiwase Kazunori,Sawano Hirotaka,Yasuga Yuji,Kuroda Yasuhiro,Kasaoka Shunji,Shirai Shinichi,Yonemoto Naohiro,Nonogi Hiroshi,The J-PULSE-Hypo Investigators
Circulation Journal 75(5), 1063-1070, 2011
… Initial electrocardiogram rhythm at the time of occurrence of the cardiac arrest showed 68.9% had ventricular fibrillation or pulseless ventricular tachycardia, 13.7% had pulseless electrical activity, and 9.1% had asystole. …
NAID 130000657658

Report From the Japanese Registry of CPR for In-Hospital Cardiac Arrest (J-RCPR)

Yokoyama Hiroyuki,Yonemoto Naohiro,Yonezawa Kazuya,Fuse Jun,Shimizu Naoki,Hayashi Toshimasa,Tsuji Teppei,Yoshikawa Kei,Wakamatsu Hiroya,Otani Nozomu,Sakuragi Satoru,Fukusaki Masahiko,Tanaka Hideki,Nonogi Hiroshi,the J-RCPR Investigators
Circulation Journal 75(4), 815-822, 2011
… All patients, visitors and employees within the facility campus who experience a cardiopulmonary resuscitation event defined as either a pulseless or a pulse with inadequate perfusion requiring chest compressions and/or defibrillation of ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) were registered. …
NAID 130000657620

Related Pictures

★リンクテーブル★

国試過去問	「113B045」「113B044」
リンク元	「心停止」「無脈性電気活動」「PEA」
関連記事	「electric」「activity」「electrical」

「113B045」

Pulseless electrical activity
	Classification and external resources
ICD-10	I46.9
ICD-9	427.9
DiseasesDB	4166
eMedicine	med/2963

　　[★]

67歳の男性。心停止の状態で救急車で搬入された。
現病歴：今朝時頃、妻が寝室に起こしに行った際には返答があったが、1時間経っても起きて来なかった。再度呼びに行くと目を閉じたままで反応がないため、午前7時に救急車を要請した。5分後に救急隊が到着し、心停止と判断した。かかりつけ医には連絡せず、心肺蘇生を行いながら救命救急センターに搬送した。
救命救急センターでpulseless electrical activity(PEA)と判断し、心肺蘇生を継続した。研修医が胸骨圧迫を継続する傍ら、指導医が薬物投与のため静脈路の確保を行うこととした。
既往歴：20年前から糖尿病、高血圧症と診断され、内服治療を続けていた。
生活歴：喫煙歴は65歳まで20本/日を45年間。飲酒は焼酎2合/日を週3日。
搬入時に行った静脈採血の結果は以下のとおりであった。
検査所見：血液所見：赤血球 322万、Hb 10.1g/dL、Ht 31%、白血球 8,800、血小板 11万。血液生化学所見：AST 92U/L、ALT 78U/L、尿素窒素 82mg/dL、クレアチニン 9.8mg/dL、血糖 228mg/dL、Na 142mEq/L、K 9.8mEq/L、Cl 112mEq/L、Ca 8.6mg/dL。CRP 2.3mg/dL。
院内救急コールで駆け付けた内科および外科病棟当直医が、救命救急センターの研修医、指導医とともに心肺蘇生を継続した。その後も心拍は再開せず、患者の死亡が確認された。かかりつけ医に連絡をとると、この患者は糖尿病腎症による慢性腎不全のため、近々人工透析の導入予定で、最終受診は1週間前であった。死亡診断書を交付できないのはどれか。

a　死亡確認を行った内科病棟当直医
b　救命処置を補助した外科病棟当直医
c　電話で死亡報告を受けたかかりつけ医
d　救命処置を行った救命救急センターの指導医
e　救命処置を行った救命救急センターの研修医

[正答]

※国試ナビ4※　［113B044］←［国試_113］→［113B046］

「113B044」

　　[★]

67歳の男性。心停止の状態で救急車で搬入された。
現病歴：今朝時頃、妻が寝室に起こしに行った際には返答があったが、1時間経っても起きて来なかった。再度呼びに行くと目を閉じたままで反応がないため、午前7時に救急車を要請した。5分後に救急隊が到着し、心停止と判断した。かかりつけ医には連絡せず、心肺蘇生を行いながら救命救急センターに搬送した。
救命救急センターでpulseless electrical activity(PEA)と判断し、心肺蘇生を継続した。研修医が胸骨圧迫を継続する傍ら、指導医が薬物投与のため静脈路の確保を行うこととした。
静脈路確保で第一選択となる部位はどこか。