What is pulseless electrical activity (PEA) and how is it treated in pediatric resuscitation?

• A. Electrical activity with a palpable pulse; treat with high-quality CPR
• B. Electrical activity with no palpable pulse; treat with high-quality CPR and identify/treat reversible causes; defibrillation is not used unless a shockable rhythm appears
• C. A rhythm with no electrical activity; observation only
• D. A rhythm that improves with defibrillation without CPR

Answer: (B)

PEA means there is organized electrical activity on the monitor but no palpable pulse or effective heartbeat. In pediatric resuscitation, that electrical activity is not enough to sustain perfusion, so the priority is high-quality CPR to maintain blood flow while you search for and treat reversible problems (the causes often grouped as Hs and Ts). Defibrillation isn’t used for PEA because the rhythm isn’t shockable; defibrillate only if a shockable rhythm (like ventricular fibrillation or pulseless VT) appears. This approach—continue strong CPR, address reversible insults, and reserve defibrillation for a shockable rhythm—optimizes chances of restoring circulation in children.