ACLS — PEA
Pulseless electrical activity — organized rhythm without a pulse
Overview
- Pulseless electrical activity — organized rhythm without a pulse
Protocol steps
- id: 1; title: Recognize PEA; detail: Organized rhythm on monitor but NO pulse. Confirm with pulse check at carotid or femoral.; time: ; drugs:
- id: 2; title: CPR 2 Minutes Immediately; detail: Start high-quality CPR. Rate 100-120/min, depth 2-2.4 inches, full recoil. Establish IV/IO access.; time: 120; drugs:
- id: 3; title: Epinephrine ASAP; detail: Give epinephrine as soon as IV/IO established. Repeat every 3-5 minutes.; time: ; drugs: name: Epinephrine; dose: 1mg IV/IO; interval: q3-5min
- id: 4; title: Search for Reversible Causes; detail: H's: Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo/Hyperkalemia, Hypothermia. T's: Tension pneumothorax, Tamponade, Toxins, Thrombosis (PE), Thrombosis (MI).; time: ; drugs:
- id: 5; title: Rhythm Check Every 2 Minutes; detail: Brief pulse and rhythm check. Shockable rhythm? Switch to VF/VT protocol. Organized rhythm with pulse? Post-arrest care.; time: 120; drugs: ; branch: true
- id: 6; title: Continue Cycles; detail: Continue CPR cycles with rhythm checks. Continue epinephrine q3-5min. Aggressively treat reversible causes. Consider bedside echo for tamponade, PE, hypovolemia.; time: 120; drugs: name: Epinephrine; dose: 1mg IV/IO; interval: q3-5min (continue)
Source and review
- AHA ACLS Guidelines 2020; Panchal et al., Circulation 2020. Last reviewed: 2024-11-01