What is Pulseless Electrical Activity (PEA)?

What Is Pulseless Electrical Activity (PEA)?

Pulseless Electrical Activity (PEA) occurs when the patient has organized cardiac electrical activity, but doesn't have a palpable pulse. Pulseless Electrical Activity (PEA) is different from other irregular heart rhythms like ventricular tachycardia (Vtach) and ventricular fibrillation (Vfib). While both PEA and asystole are not shockable rhythms, asystole does not show any cardiac electrical activity. 

There are two different types of PEA which include Pseudo-PEA and True PEA. In Pseudo-PEA, the electrical activity within the heart may produce weak squeezing that could result in pulse detection through an arterial line, POCUS pulse check, or ETCO2. However, a palpable pulse will not be present. In True PEA, there is electrical activity but the heart does not respond to at all. In addition, a pulse can be detected through any means.

how To Identify PEA An EKG?

​There is not a specific pattern for determining the presence of PEA on an ECG. In some cases, there will be a P wave, PR wave, or QRS complex. In other situations, there might be a heart rate or no heart rate at all. The main noticeable component is that there will likely be some sort of organized or semi-organized rhythm with an unresponsive patient and no pulse.

Because PEA can present in different ways, it is important to integrate the ECG reading with an assessment of the patient, particularly pulse detection, in order to accurately diagnose this heart arrhythmia.

Triggers of PEA

It is important to first identify the underlying cause of the cardiac arrest and treat it to bring the heart back to a shockable state as PEA is not a shockable rhythm. Diagnosing the cause of PEA involves a thorough knowledge of the H's and H's; otherwise known as the reversible causes. These include Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo-Hyperkalemia, Hypothermia, Tension Pneumothorax, Cardiac Tamponade, and Pulmonary and Coronary Thrombosis.

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