Case 5 - Pulseless Electrical Activity

Question 1

In the case of pulseless electrical activity, all patient care is centered around _____.

A. High quality CPR for two minutes
B. IV/IO access
C. Advanced airways

Answer 1

A. High quality CPR for two minutes

Incorrect:
B. IV/IO access occurs during CPR. High quality CPR is IMPERATIVE in the survival of cardiac arrest patients.

C. Advanced Airways - only take precedence in the case of a hypoxic arrest or if BVM ventilations are ineffective (p. 111)

Question 2

T/F: ANY organized rhythm without a pulse is considered a PEA.

Answer 2

True*.

• The “organized rhythm” must have QRS complexes that are similar in spacing and morphology.

Question 3

Which of the following is the most common initial rhythm following successful defibrillation?

A. Ventricular tachycardia
B. Pulseless electrical activity
C. Sinus bradycardia

Answer 3

B. Pulseless electrical activity (p. 110)

Question 4

What is the first line drug for asystole/PEA?

A. Epinephrine 1:1,000 IV/IO q3-5 min
B. Epinephrine 1:10,000 IV/IO q3-5 min
B. Lidocaine 1 mg/kg IV/IO q3-5 min
C. Magnesium 2 gm IV/IO q3-5 min

Answer 4

B. Epinephrine 1:10,000 IV/IO q3-5 min

Incorrect:
A. Epinephrine 1:1,000 IV/IO q3-5 min
- This is a dose for anaphylaxis, not cardiac arrest.

B. Lidocaine 1 mg/kg IV/IO q3-5 min
- This is first line treatment for VF/VT

C. Magnesium 2 gm IV/IO q3-5 min
- This is first line treatment for Torsades de Points

Question 5

When should the defibrillator be charged in a PEA that has terminated into a shockable rhythm?

A. During the pulse check
B. During intubation attempts
C. While CPR is ongoing

Answer 5

A. During the pulse check

Question 6

List the Hs of cardiac arrest and Tx

Answer 6

Hypovolemia - fluid replacement with NS
Hypoxia - Advanced airway with supp. oxygen
Hypothermia - rewarming
H+ ions - 50-100 mEq sodium bicarbonate
Hypo/hyperkalemia - 1 gm CaCl2 IV

Question 7

List the Ts of cardiac arrest and Tx

Answer 7

Toxins - specific to toxin
Tension pneumothorax - needle decompression
Tamponade - cardiac - rapid transport to trauma center
Thrombus - pulmonary - rapid transport
Thrombus - coronary - rapid transport