PEA includes:
* Electromechanical Dissociation (EMD)     * Pseudo EMD
* Idioventricular Rhythm                                 * Ventricular Escape Rhythm
* Bradyasystolic Rhythm                                 * Postdefibrillation Idioventricular Rhythm

Perform CPR until Monitor-Defibrillator attached

Assess Blood Flow using Doppler ultrasound ,
End-Tidal CO2 ,  Echocardiography or Arterial Line

Consider Possible Causes:
* Hypoxia (Ventilation)                                                              * Hypovolemia (volume infusion)
* Cardiac Tamponade (Pericardiocentests)                         * Acidosis (*)
* Tension Pneumothorax (Needle decompression)
* Drugs Overdose such as Tricyclics, Digitalis, Beta Blockers, Calcium Channal Blockers
* Hyperkalemia (Sodium Bicarbonate is Class I )
* Hypothermia (see Hypothrmia Algorhithm)
* Massive Pulmonary Embolism (Surgery ,Thrombolytics)
* Massive acute Myocardial Infarction (see MI algorhithm)

Repeat every 3-5 min

If absolute Bradycardia (< 60/min) or
Relative Bradycardia

Repeat every 3-5 min , up to total of 0.03-0.04 mg/kg

3-5 min after the previous dose

3-5 min after the previous dose

3-5 min after the previous dose

3-5 min after the previous dose

Class I *If patient has known preexisting Hyperkalemia
Class IIa *If known preexisting Bicarbonate responsive acidosis 
*Tricyclic Antidepressants Overdose        *To alkalinize the urine in drug overdoses
Class IIb *If intubated and continued long arrest interval
                  *Upon return of spontaneous circulation after long arrest interval

** If this approach fails , several Class II b dosing regimens can be considered:
    > Intermediate: Epinephrine 2-5 mg , IV push , every 3-5 min.
    > Escalating:  Epinephrine 1 mg - 3 mg - 5 mg , IV push , 3 min apart.
    > High :  0.1 mg / kg , IV push , every 3-5 min.

Paramedic Neomi Zvi - Feb 2000

AHA ; ACLS ; 1994 ; 1-21  -  1-23