Acute Care 13: Pulseless Electrical Activity Algorithm—
Adult and Pediatric
| Assess the patient
for responsiveness/breathing. Activate the emergency response system. Get AED or Monitor/Defibrillator.  |
| Check pulse (no more
than 10 seconds) |
| If no pulse, begin
CPR. PEA - Rhythm on the monitor but the patient has no pulse. Complete the primary and secondary ABCD survey. |
| Place advanced
airway; confirm and secure. Establish effective oxygenation and ventilation. Identify the rhythm on the monitor. Administer appropriate drugs for rhythm and condition. Search for and treat reversible causes. If available, bedside ultrasound may help to determine contractility and filling status of the heart. |
 | |||
| Hs | Ts | ||
| Hypovolemia | Tablets | ||
| Hypoxia | Tamponade | ||
| Hydrogen-ion acidosis | Tension pneumothorax | ||
| Hyper-/hypokalemia | Thrombosis,coronary | ||
| Hypothermia | Thrombosis, pulmonary |
Give epinephrine 1 mg IV push. PEDS: Epinephrine 0.01 mg/kg IV/IO or 0.1 mg/kg ET. (If ET, use 1:1000 preparation.) Repeat every 3 to 5 minutes. May use 1 dose of vasopressin 40 units IV/IO in place of first or second dose of epinephrine (PEDS: not recommended in pediatric patients.)
Atropine is not routinely recommended in PEA. However, in bradycardic PEA, it may be pharmacologically reasonable to administer atropine 1 mg IV/IO. Repeat as needed at 3- to 5-minute intervals to a total dose of 0.04 mg/kg (approximately 3 mg for adults). PEDS: Dose is 0.02 mg/kg IV/IO. Repeat at 3- to 5-minute intervals to a total dose of 0.04 mg/kg (~3 mg for adults).