Pulseless Electrical Activity
Pulseless Electrical Activity (PEA) Rhythm
PEA rhythm occurs when any heart rhythm that is observed on the electrocardiogram (ECG) does not produce a pulse. PEA can come in many different forms. Sinus Rhythm, tachycardia, and bradycardia can all be seen with PEA.
Performing a pulse check after a rhythm/monitor check will ensure that you identify PEA in every situation.
Pulseless electrical activity usually has an underlying treatable cause. The most common cause in emergency situations is hypovolemia.
PEA is treated by assessing and correcting the underlying cause. These causes can be summed up in the 6 H’s and 6 T’s of ACLS. Use the link to review the H’s and T’s.
When an underlying cause for pulseless electrical activity cannot be determined, PEA should be treated in the same fashion as asystole
Pulseless electrical activity is treated using the right branch of the puslesless arrest arrest algorithm. Click below to view the pulseless arrest algorithm diagram. When done click again to close the diagram.
Pulseless Arrest Algorithm Diagram.»
Pop-Quiz:
Question #1: If you saw the rhythm below after defibrillation, how would you determine if it is pulseless electrical activity?
click here for answer»
Question #2: What is the most common cause of PEA?
click here for answer»
This site is supper! Am ready for my interview tomorrow thank you i polished up
This site has really helped me sort out all of the ACLS info. I work in an outpatient surgery center and in 7 yrs have only seen 1 arrest. This makes it more real and easier to remember.
Jeannie Daniel has a typo in her response. The normal QRS interval IS NOT 0.6-0.1 seconds, it is 0.06-0.1 seconds.
Thanks for pointing out the error on the measurement with reference to a comment on the site. I have edited that comment to show the correct QRS interval of 0.06 – 0.10 s.
Thanks for pointing that out.
Kind regards,
Jeff
what is the clue that PEA is caused by a drug overdose?
Most common clues for drug induced PEA would be: Prolongation of the QT interval on ECG, empty bottles at the scene, pupils dilated or constricted and less reactive to light.
Kind regards,
Jeff
I’m preparing for my ACLS, thanks God i found this site! More power, and thank you so much Jeff
Thank you ..very well explained and simple to follow
many thanks for discussion, it help me more
Very helpful. Thanks Jeff.
WHAT IS MEANT BY BUNDLING AS SHOWN AS A RESULT OF AN EKG
You are most likely referring to an anomaly seen on an ECG called a bundle branch block.
A bundle branch block refers to a defect in the hearts electrical conduction system.
With a bundle branch block, when the heart’s electrical activity begins in the SA Node (sionatrial node), the impulse travels down through the AV node (atrioventricular node) from the AV node, the impulse travels down the “Bundle of His” and divides into the right and left bundle branches.
When one of these branches becomes injured, it slows or blocks the conduction of electricity. The electricity has to go somewhere so it results in altered pathways for ventricular depolarization.
This causes the ECG to look different. The most common difference seen is a Wide QRS due to the increased conduction time. A bundle branch block can be diagnosed when the duration of the QRS complex exceeds 120 ms.
Hope this helps.
Kind regards,
Jeff
Dear Jeff,
You state that the BBB is diagnosed when the duration of the QRS exceeds 120ms. Since the QRS is always mapped in s (seconds), this reference is confusing. You should explain that the 120ms = 0.12s. Furthermore, you should add that the normal QRS interval is 0.06s – 0.10s. Technically, an incomplete BBB will measure between 0.10s – 0.12s. 0.12s will measure three small boxes on the ECG paper. Each small box is 0.04s. Complete BBB will measure greater than 0.12s. These BBB can be constant or intermittent.
Jeannie Daniel RN, BSN ICU
You and this site is a blessing!!!!!!!!!!!!!!!!!