Online ACLS Course

Chapter 11 : Pulseless Electrical Activity

Pulseless electrical activity (PEA) is lack of palpable pulse or cardiac contraction even with an organized cardiac electrical activity. Even though the heart is producing organized electrical activity, no mechanical activity is produced. There will be no contractions of the cardiac muscles. Any organized rhyme without a pulse is PEA (except VF, VT and asystole) and includes: idioventricular rhythms, ventricular escape rhythms, post-defibrillation idioventricular rhythms, and Bradyasystolic rhythms.

Video Demonstration

Pulseless Electrical Activity
Pulseless electrical activity

PEA can be caused by many factors and are represented as H’s and T’s:

H’sT’s
Hypovolemia – Decreased blood volumeTension pneumothorax – air in the pleural space around the lung (lung collapses)
Hypoxia- decreased partial pressure of oxygen in bloodTamponade – compression of the heart produced by excess fluid surrounding the heart
Hydrogen ion (acidosis) – Increase in the concentration of H ions in bloodToxins – poisonous substances
Hyper-/hypokalemia –abnormally high or low potassium concentration in the bloodThromobosis (pulmonary) – formation of a blood clot which blocks a blood vessel in lungs
Hypothermia – body temperature less than 30 degrees C (86 degrees F)Thrombosis (coronary) –formation of a blood clot which blocks a blood vessel in heart