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

• 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
• Absent pulse
• High/low blood pressure with normal pulse pressure / wide pulse pressure / narrow pulse pressure

Skin

• Skin examination of patients with pulseless electrical activity is usually normal.

HEENT

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

OR

• Abnormalities of the head/hair may include ___
• Evidence of trauma
• Icteric sclera
• Nystagmus
• Extra-ocular movements may be abnormal
• Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
• Ophthalmoscopic exam may be abnormal with findings of ___
• Hearing acuity may be reduced
• Weber test may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
• Rinne test may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
• Exudate from the ear canal
• Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
• Inflamed nares / congested nares
• Purulent exudate from the nares
• Facial tenderness
• Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae

Neck

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

OR

• Jugular venous distension
• Carotid bruits may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
• Lymphadenopathy (describe location, size, tenderness, mobility, and symmetry)
• Thyromegaly / thyroid nodules
• Hepatojugular reflux

Lungs

• Pulmonary examination of patients pulseless electrical activity with is sometimes abnormal based on the cause.

OR

• Asymmetric chest expansion OR decreased chest expansion
• Lungs are hyporesonant OR hyperresonant
• Fine/coarse crackles upon auscultation of the lung bases/apices unilaterally/bilaterally
• Rhonchi
• Normal/reduced tactile fremitus

Heart

• Cardiovascular examination of patients with pulseless electrical activity is usually abnormal.
• Chest tenderness upon palpation
• Heave / thrill
• Friction rub
• S1
• S2

Abdomen

• Abdominal examination of patients with pulseless electrical activity is usually normal.

Back

• Back examination of patients with pulseless electrical activity is usually normal.

Genitourinary

• Genitourinary examination of patients with pulseless electrical activity is usually normal.

Neuromuscular

• Neuromuscular examination of patients with pulseless electrical activity is usually normal.

Extremities

• Extremities examination of patients with pulseless electrical activity is usually normal.