ACLS review: Pulseless Electrical Activity- part 2

Primary Survey- Assess CABs

·         Assess responsiveness and pulse

·         Active EMS system

·         Call for defibrillator/monitor

Note:  If a rhythm is present on the monitor but the pulse is absent (eg,PEA), CPR should be started immediately, beginning with chest compressions, and should continue for 2 minutes before the rhythm check is repeated.

Primary Survey- Assess CABs

·         Circulation- give uninterrupted chest compressions for two minutes

·         Airway- Open airway

·         Breathing- give positive pressure ventilation

·         Defibrillator- attach and assess rhythm

·         Look for pulse using doppler

Look for Pulse Using Doppler

·         A doppler will help distinguish between a pulseless state and profoundly weak cardiac contractions with a low cardiac output (pseudo-PEA).

·         True PEA:  no pulse and no perfusion

·         Pseudo-PEA: weak pulse detected doppler or echocardiography and severely compromised perfusion

Secondary Survey

·         Intubate and secure airway device.

·         Oxygenate with 100% O₂.

·         IV access

Note: Given the potential association of PEA with hypoxemia, placement of an advanced airway is theoretically more important than during VF/pulseless VT and might be necessary to achieve adequate oxygenation or ventilation.


Reviewed 2/28/16