Advanced Cardiovascular Life Support (ACLS) Practice Exam

Which situation best describes pulseless electrical activity?

1. Atrial fibrillation with no pulse

2. Sinus rhythm without a pulse

3. Ventricular tachycardia with a pulse

4. Asystole with normal waveforms

The correct answer is: Sinus rhythm without a pulse

Pulseless electrical activity (PEA) occurs when there is organized electrical activity on the electrocardiogram (ECG), but the heart does not produce an effective mechanical contraction, leading to a lack of palpable pulse. The situation that best illustrates this condition is sinus rhythm without a pulse. In this scenario, although the electrical signals suggest that the heart is attempting to beat in a coordinated manner, it fails to achieve adequate contraction force, thus resulting in no detectable pulse. This delineation is critical in the context of advanced life support because PEA requires immediate intervention to restore effective cardiac output, whereas other states, like ventricular tachycardia with a pulse, indicate a different rhythm and clinical approach. Recognizing pulseless electrical activity is vital for early recognition and treatment in cardiac arrest situations.