Wednesday, February 27, 2008


Pulseless electrical activity is a clinical condition characterized by loss of palpable pulse in the presence of recordable cardiac electrical activity...

He was 12, a patient I had seen before because of his frequent hospital visits. I remembered him because despite being confined to a wheel chair, he and his mother always had a smile as I passed. Despite being just another face in the oceans of faces making up my hospital, despite being part of a specialty completely apart from pediatrics. Today he got short of breath and was taken to the nearest emergency room. There they discovered a pneumonia, and arranged a transfer to a hospital with a PICU.

…PEA is caused by the inability of cardiac muscle to generate a sufficient force despite an electrical depolarization…

He seemed fairly stable. So much so that a direct admission to the PICU was arranged, with the intention of just passing through the ER on his way upstairs. However, on pulling into the ER parking lot he was not doing as well as could be hoped. His oxygen saturation dropped, his breathing began to decline, and he was intubated in the ambulance. As the ambulance stopped and the EMTs in the back continued their resuscitation, the driver ran inside to get our assistance. Somewhere about that time, his pulse disappeared, though the monitors continued to display cardiac activity.

…The overall mortality rate is high in patients in whom PEA is the initial rhythm during cardiac arrest…

I performed chest compressions while we brought him inside. The code was run quickly and efficiently by the PICU attending, who had come down to meet his patient. Epinephrine, calcium, bilateral needle decompressions, pericardiocentesis. Despite everything, he did not survive.

In the last month in the ER I've participated in more emergent resuscitations than the rest of my internship to date. The good news is that I now am not nervous about running a code. The bad news is that I’ve acquired that calmness through practice.

PEA quotes taken from