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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.


Question #1: If you saw the rhythm below after defibrillation, how would you determine if it is pulseless electrical activity?
EKG of Sinus Rhythm with PVC's
click here for answer

Question #2: What is the most common cause of PEA?
click here for answer

You should check for a carotid or femoral pulse

  74 Responses to “Pulseless Electrical Activity”

  1. On the Hs and Ts sheet, Trauma and Hypoglycemia are crossed out but not removed. Can you explain?

    • AHA has removed these from the H and T’s for the following reasons:
      1. Trauma now has it own specific treatment recommendations within AHA ACLS protocol under special resuscitation situations.
      2. Hypoglycemia was removed because the blood glucose check is now a routine standard that is expected to be done with any changes in level of consciousness. It is still very important and should not be neglected.
      Kind regards,

  2. how does PEA tracing looks like

  3. Very helpful for renewal. I recommend putting it on your phone

  4. I might have missed this somewhere on the website, but what is the difference between performing a unsynchronized shock-defibrillation and a synchronized cardioversion? Is this just based on the rhythm identified on the monitor?

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