Pulseless Electrical Activity

Pulseless Electrical Activity
Pulseless electrical activity (PEA) is a clinical condition characterized by unresponsiveness and the lack of a palpable pulse in the presence of organized cardiac electrical activity. 


Heart Rate: No pulse present

Rhythm: Can appear organized (with no pulse present)

P wave: present or suppressed

QRS Complex: appear organized

ST segment: present 

Check the Patient:

  • Level of Consciousness (likely unresponsive)
  • Hypotension (Systolic Less than 90mmHg.)
  • Chest Discomfort or Shortness of Breath
  • Saturation: less than 92% 
  • HR can be normal 


  • Consider Oxygenation
  • Monitor and Continue Observing
  • Obtain IV/IO Access
  • Hypoxia and Hypovolemia most common cause of PEA


  • Initiate CPR
  • Epi 1 mg 
  • Consider Reversible Causes

H's and T's: 

  • Hypoxemia
  • Hypovolemia
  • Hydrogen Ions (Acidosis)
  • Hypo/Hyperkalemia
  • Hypothermia
  • Toxins
  • Thrombosis (Pulmonary/Cardiac)
  • Tension Pneumothorax
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