Pulseless electrical activity physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

A rapid physical examination should be performed to identify rapidly reversible causes of PEA. Absence of palpable pulses is the main finding. Depending upon the cause of PEA, physical findings can be distended neck veins, tracheal deviation, unilateral absence of breath sounds, tachycardia, decreased skin turgor, traumatic chest, cool extremities, and cyanosis.

Physical Examination

A rapid physical examination should be performed to identify rapidly reversible causes of PEA:

Pulse

• Absence of palpable pulses is the main finding.

Depending upon the cause, the following might be found:

Neck

• Distended neck veins suggests cardiac tamponade
• Tracheal deviation suggests tension pneumothorax

Lungs

• Unilateral absence of breath sounds suggests tension pneumothorax

Heart

• Tachycardia

General

• Decreased skin turgor
• Traumatic chest
• Cool extremities  
• Cyanosis

Appearance of the Patient

• Patients with [disease name] usually appear [general appearance].

Vital Signs

• High-grade / low-grade fever
• Hypothermia / hyperthermia may be present
• Tachycardia with regular pulse or (ir)regularly irregular pulse
• Bradycardia with regular pulse or (ir)regularly irregular pulse
• Tachypnea / bradypnea
• Kussmal respirations may be present in _____ (advanced disease state)
• Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
• High/low blood pressure with normal pulse pressure / wide pulse pressure / narrow pulse pressure

Skin

• Skin examination of patients with [disease name] is usually normal.

OR

• Cyanosis
• Jaundice
• Pallor
• Bruises

• Description (Adapted from Dermatology Atlas)

  Description (Adapted from Dermatology Atlas)

• 

  Description (Adapted from Dermatology Atlas)