Pulseless Electrical Activity (PEA)

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Section 4 - CARDIAC

4.04 PULSELESS ELECTRICAL ACTIVITY (PEA)

CONSIDER MEDICAL ETIOLOGY OF PEA AND REFER TO APPROPRIATE PRACTICE PARAMETER:


  • Initiate 5 cycles of CPR (30:2) for approximately 2 minutes to allow blood to circulate and continue throughout resuscitation, minimizing interruptions. Assist ventilations with OXYGEN @ 100% via BVM. DO NOT HYPERVENTILATE.
  • Consider securing the airway with KING TUBE / INTUBATION and establish IV or IO.
  • If hypovolemia suspected, fluid bolus 200 - 300 ml. If time permits.


If bradycardia, relative bradycardia or vagally stimulated such as patients found in the restroom.

  • First, ATROPINE SULFATE 0.5 -1.0 mg rapid IVP. Repeat every 3 - 5 minutes up to a total of 3 mg.
  • Apply TCP, set at maximum Milliamp. If pulse generated, decrease dosage to setting which still maintains a palpable pulse. If unsuccessful, reattempt capture every 3 - 5 minutes as above. Check for pulse and rhythm change after all interventions.
  • EPINEPHRINE 1:10,000 1 mg IVP or IO Repeat EPINEPHRINE every 3 - 5 minutes of continued arrest.

If NO bradycardia or relative bradycardia


If patient combative post resuscitation, refer to ANALGESIA /SEDATION PARAMETER (2.04).