NREMT Paramedic Cognitive ExamCardiology & ResuscitationMedium
A 72-year-old male is in cardiac arrest. CPR is ongoing. The cardiac monitor shows a rhythm with organized electrical activity at a rate of 70 bpm, but no palpable pulse is detected. What is the MOST appropriate next action?
- AAdminister epinephrine 1 mg IV
- BContinue CPR and search for reversible causes
- CAdminister atropine 1 mg IV
- DDefibrillate immediately
Show answer & explanationAnswer & explanation
Correct answer: A. Administer epinephrine 1 mg IV
The patient is experiencing Pulseless Electrical Activity (PEA), characterized by organized electrical activity on the ECG without a palpable pulse. The primary medication for PEA is epinephrine, which is administered every 3-5 minutes during CPR. Simultaneously, the team should focus on identifying and treating reversible causes (H's and T's).
Why the other options are wrong
- B. While searching for reversible causes is crucial, epinephrine is administered concurrently as part of the ACLS PEA algorithm.
- C. Atropine is for symptomatic bradycardia, not cardiac arrest rhythms like PEA.
- D. Defibrillation is for shockable rhythms (VF/pVT), not PEA.
Pulseless Electrical Activity (PEA) Management
Pulseless Electrical Activity (PEA) is a non-shockable cardiac arrest rhythm characterized by organized electrical activity on the ECG but no palpable pulse, requiring high-quality CPR, epinephrine, and prompt identification/treatment of reversible causes.
- PEA is a non-shockable rhythm.
- Epinephrine 1 mg IV/IO is administered every 3-5 minutes.
- High-quality CPR is continuous.
- Focus on identifying and treating the 'H's and 'T's (reversible causes).
Memory trick: PEA: Epi + H's & T's!