Electromechanical dissociation or pulseless electrical activity implies that there is electrical activity of the heart without mechanical activity. A definite diagnosis can rarely be made clinically because feeble contraction of the heart may produce no pulse, no detectable heartbeat, and no heart sounds, but the distinction is irrelevant since both absence of mechanical activity and undetectable mechanical activity carry an equally poor prognosis except when they are transient phenomena during a cardiac arrest or there is a specific remediable cause. Therefore search for and recognition of specific and correctable causes of the clinical picture of electromechanical dissociation is of prime importance (Fig 1). If no evidence exists for any of the specific causes, cardiopulmonary resuscitation should be continued with the usual associated procedures of airway security, establishing venous access, and treatment with epinephrine. No recommendation based on sound scientific evidence can be made for the routine use of calcium salts or alkalizing agents, although they may be of value in some circumstances.
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