What is Pulseless Electrical Activity?

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Definition and Treatment of Pulseless Electrical Activity:

Pulseless electrical activity is defined as the presence of a discernible rhythm on cardiac monitoring in a patient who is clinically in cardiac arrest with no palpable pulses.

Any patient with a non-shockable rhythm should receive CPR and airway ventilation with 100% oxygen.

NOTE: Unlike ventricular fibrillation and ventricular tachycardia, atrial fibrillation is not a shockable rhythm during a cardiac arrest with no palpable pulses.

Furthermore, IV access must be established so ACLS medications such as epinephrine, vasopressin and atropine can be administered.

Causes of Pulseless Electrical Activity:

Pulseless electrical activity is caused by the 6Hs and 6Ts:

Hs: hypovolemia, hypoxia, hydrogen ions (acidosis), hypothermia, hypoglycemia, hyper/hypokalemia.

Ts: tamponade (cardiac), tension pneumothorax, thrombosis (MI, PE) trauma (hypovolemia), tablets (drugs), and toxins.

Additional Reading:

Basic Cardiology

1. Electrical Activity of the Heart
2. Heart Muscle Mechanics
3. Heart Sounds and Murmurs
4. Additional FAQ on Heart Sounds and Murmurs
5. Cardiac Conduction Diagram
6. Blood Pressures in Cardiac Chambers
7. What is Pulsus Paradoxus?
8. FAQ on Heart Murmurs and Mechanisms of Turbulent Flow
9. Notes on Fetal Circulation
10. FAQ on Ischemic Myocardial Infarction
11. FAQ on Electrocardiograms / ECG / EKG
12. FAQ on Cardiac Conduction
13. The Heart as a Pump, the Cardiac cycle and Cardiac Output
14. What are the most common causes of aortic stenosis?
15. What is Pulseless Electrical Activity?
16. Causes and Complications of Arteriovenous Fistulas
17. CHADS2 Score for Atrial Fibrillation Stroke Risk
18. How to Reduce Blood Pressure without Medications?
19. Types of Shock
20. Locations of Heart Murmurs on Chest Wall
21. Types of Heart Blocks

Electrocardiogram (EKG/ECG) Topics

1. EKG Chest Leads
2. EKG Limb Leads
3. Quick 12-Lead ECG/EKG Format

Cardiology Videos

1. Video of Cardiology Examination in a Clinical Setting

Medical Images

Useful Medical Images & Diagrams (link opens in a new window)

Related Topics

1. Thorax Anatomy
2. Vascular Disorders
3. Heart Disorders
4. Histology of the Cardiovascular System
5. Jugular Venous Distention Workup
6. ER Chest Pain Workup
7. Cardiac Examination for Internal Medicine
8. FAQ on Blood Pressure
9. FAQ on principles of fluid and flow dynamics of Blood

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