Note: Your progress in watching these videos WILL NOT be tracked. These training videos are the same videos you will experience when you take the full ProPALS program. You may begin the training for free at any time to start officially tracking your progress toward your certificate of completion.

Pulseless electrical activity, most commonly known as PEA, is a condition where the electrical activity of the heart is not accompanied by a palpable or effective pulse.

In this lesson, we'll look closer at PEA, and outline several possible causes, including an important caveat or warning. And at the end of the lesson, we'll provide a preview of the next section in the ProPALS course: PALS Pharmacology.

Treatable Causes for PEA

It's always important to treat the patient's symptoms, rather than rely on the ECG readout alone. Underlying and treatable causes for PEA include:

  • Pulmonary thrombosis
  • Coronary thrombosis
  • Tension pneumothorax
  • Cardiac tamponade
  • Hypovolemia
  • Hyperkalemia
  • Hypoxia
  • Hydrogen ion (acidosis)

Pro Tip: It's important to rule out any and all of the H's and T's as underlying causes for pulseless electrical activity in order to correct the mechanical disassociation that could be causing the cardiac arrest.

Warning: The ECG interpretation for a patient exhibiting signs of PEA could be the same as normal sinus rhythm. Which is why treating the patient's symptoms, particularly when it comes to pulseless electrical activity, is so important. Rather than merely reacting to and relying on the rhythms that are being displayed on the ECG monitor.

A Word About Pharmacology (A Preview)

It's important that you know basic information about medications and other interventions used in the PALS algorithms. A basic understanding of pharmacology information includes the indications, contraindications, and methods of administration for each. You'll also need to know when to use which drug based on each clinical situation.

Medications and interventions that we'll be looking at in detail in the upcoming ProPALS course section are:


Adenosine is a prescription drug used for conversion to sinus rhythm of paroxysmal supraventricular tachycardia (PVST), including that associated with accessory bypass tracts (Wolff-Parkinson-White Syndrome).

Adenosine is available under the following different brand names: Adenocard, and Adenoscan.


Amiodarone is used to treat certain types of serious (possibly fatal) irregular heartbeat (such as persistent ventricular fibrillation/tachycardia). It is used to restore normal heart rhythm and maintain a regular, steady heartbeat.

Amiodarone is known as an anti-arrhythmic drug. It works by blocking certain electrical signals in the heart that can cause an irregular heartbeat.


Atropine is a medication used to treat certain types of nerve agent and pesticide poisonings as well as some types of slow heart rate and to decrease saliva production during surgery. It is typically given intravenously or by injection into a muscle.


Dopamine is indicated for the correction of hemodynamic imbalances present in the shock syndrome due to myocardial infarction, trauma, endotoxic septicemia, open-heart surgery, renal failure, and chronic cardiac decompensation as in congestive failure.


Adrenaline, also known as epinephrine, is a hormone and medication. Adrenaline is normally produced by both the adrenal glands and a small number of neurons in the medulla oblongata where it acts as a neurotransmitter involved in regulating visceral functions.

It's used in emergencies to treat very serious allergic reactions to insect stings/bites, foods, drugs, or other substances. Epinephrine acts quickly to improve breathing, stimulate the heart, raise a dropping blood pressure, reverse hives, and reduce swelling of the face, lips, and throat.


Lidocaine is used to relieve nerve pain after shingles (infection with the herpes zoster virus). This type of pain is called post-herpetic neuralgia. Lidocaine helps to reduce sharp/burning/aching pain as well as discomfort caused by skin areas that are overly sensitive to touch. Lidocaine belongs to a class of drugs known as local anesthetics. It works by causing a temporary loss of feeling in the area where you apply the patch.

Lidocaine is available under the following different brand names: Lidocaine CV, and Lidopen.

Magnesium Sulfate

Magnesium sulfate is a naturally occurring mineral used to control low blood levels of magnesium. Magnesium sulfate injection is also used for pediatric acute nephritis and to prevent seizures in severe pre-eclampsia, eclampsia, or toxemia of pregnancy.

Magnesium sulfate is available under the following different brand names: MgSO4.


Oxygen is the odorless gas that is present in the air and necessary to maintain life. Oxygen may be given in a medical setting, either to reduce the volume of other gases in the blood or as a vehicle for delivering anesthetics in gas form. It can be delivered via nasal tubes, an oxygen mask, or an oxygen tent. Patients with lung disease or damage may need to use portable oxygen devices on a temporary or permanent basis.


Pronestyl (procainamide hydrochloride) is a cardiac antiarrhythmic drug used to help keep the heart beating normally in people with certain heart rhythm disorders of the ventricles (the lower chambers of the heart that allow blood to flow out of the heart).

The brand name Pronestyl is discontinued in the U.S. Generic versions may be available.