Pulseless Electrical Activity Clinical Presentation

Updated: Mar 27, 2018
  • Author: Sandy N Shah, DO, MBA, FACC, FACP, FACOI; Chief Editor: Jose M Dizon, MD  more...
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History and Physical Examination


Knowledge of the patient's prior medical conditions allows prompt identification and correction of reversible causes. For example, a debilitated patient who develops acute respiratory failure follwed by pulseless electrical activity (PEA) may have a pulmonary embolus. If an elderly woman develops PEA 2-5 days after a myocardial infarction, a cardiac etiology should be considered (ie, cardiac rupture, recurrent infarction). History of previous drug intake is crucial, enabling prompt treatment of patients in whom drug overdose is suspected. The presence of PEA in the setting of trauma makes hemorrhage (hypovolemia), tension pneumothorax, and cardiac tamponade the more likely causes.

Physical examination

By definition, patients with PEA have no pulse in the presence of organized electrical activity. Therefore, the physical examination should focus on identification of reversible causes; for example, tracheal shift or the unilateral absence of breath sounds indicates tension pneumothorax, whereas normal lung sounds and distended jugular veins point to cardiac tamponade.