ELS Priorities

In ELS there are two priorities, namely:

To assess cardiac movement

In assessing cardiac movement, three possibilities exist:

  • There is no cardiac movement. If the heart is seen to be motionless and this corresponds with asystole on the monitor, survival is highly unlikely. Identifying this clinical picture can aid the practitioner in decision making during a cardiac arrest.
  • There is cardiac movement with sinus rhythm on the monitor. If the carotid pulse is absent, the patient has a condition known as ‘pseudo-PEA’ in which there is mechanical action of the heart, but of insufficient magnitude to generate a pulse.(15) The importance of identifying this condition is that survival is much higher in these patients.(16)
  • There is visible ventricular fibrillation. Patients thought to be in asystole have been found to have VF on echocardiography.(17) Such patients obviously require cardioversion.
To identify remediable pathology

The two main conditions that may respond to immediate treatment are:

  • Pericardial effusion sufficiently large to cause tamponade. Tamponade is a physiological diagnosis that is virtually impossible to make during cardiac arrest without the use of echo. If a large effusion is identified, this needs to be put into context with the overall clinical situation, but pericardiocentesis must be considered

 

  • Massive pulmonary emoblism (PE). Features of massive PE include presence of visible thrombus in the heart, a right ventricle diameter to left ventricle diameter ratio greater than one, and a dilated inferior vena cava (see the session Soft Tissue Musculoskeletal / Ultrasound / Skills of Carrying Out Assessment For Abdominal Aortic Aneurysm). If massive PE is strongly suspected, appropriate action should be taken (eg thrombolysis). The image on the right shows a visible thrombus in the heart on apical view