Daily Bolus of LR: Pulseless Electrical Activity

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April 8, 2011 by dailybolusoflr

Pulseless Electrical Activity (or PEA)


·         PEA is defined as an organized electrical rhythm (complexes seen on the monitor) without the presence of a palpable pulse.


·         When you have a patient who presents in PEA, focus should be not simply on providing ACLS medication/CPR resuscitation but also on identifying what are known as the ‘reversible causes’ which are associated with PEA.


Reversible Causes:


5 H’s                                                      5 T’s

Hypoxia                                                Toxins

Hypovolemia                                     Tamponade (cardiac)

Hydrogen ion (acidosis)                 Tension pneumothorax

Hypo-/hyperkalemia                      Thrombosis, pulmonary

Hypothermia                                     Thrombosis, coronary


ACLS guidelines:


·         PEA and asystole are treated the same, as they are both non-shockable rhythms

·         CPR for 2 minutes before a repeat rhythm check

·         Obtain IV/IO access

o   Vasopressor can be given as soon as is reasonable given the situation (epinephrine 1mg q 3-5 minutes)

o   Atropine is no longer indicated

·         As hypoxia is a major etiology of PEA, consider establishment of an advanced airway early




Circulation. 2010;122[suppl 3]:S729 –S767


Linda Regan, MD FACEP

Program Director, Emergency Medicine Residency

Johns Hopkins Medical Institutions


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