Cardiac Arrest (PEA) — ABEM Board MCQ

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EasyEmergency MedicineCardiac Arrest (PEA)ABEM Board

During a cardiac arrest with pulseless electrical activity, high-quality CPR is underway and IV access is established. Which medication dosing is guideline-concordant?

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Correct answer: A — Epinephrine 1 mg IV every 3-5 minutes

In adult cardiac arrest with a nonshockable rhythm such as pulseless electrical activity (PEA), the guideline-concordant medication is epinephrine 1 mg IV/IO every 3–5 minutes while high-quality CPR continues and reversible causes are sought. Amiodarone and lidocaine are antiarrhythmics used for shock-refractory VF/pulseless VT, not routine PEA. Atropine is not recommended for routine PEA/asystole cardiac arrest. Calcium chloride is not given routinely in PEA; it is reserved for specific suspected causes such as hyperkalemia, hypocalcemia, or calcium-channel blocker toxicity.

Reference: American Heart Association. Adult Cardiac Arrest Algorithm: 2025 American Heart Association Guidelines for CPR and ECC. https://www.heart.org/-/media/CPR-Files/CPR-Guidelines-Files/2025-Algorithms/Algorithm-ACLS-CA-250527.pdf