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PEA Cardiac Arrest — RACP Adult Medicine MCQ

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ModerateCardiologyPEA Cardiac ArrestRACP Adult Medicine

A 55-year-old man has a cardiac arrest. Monitor shows an organised QRS complex at 40 bpm but he has no pulse (pulseless electrical activity/PEA). CPR is commenced. What is the most important intervention beyond CPR and adrenaline?

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Correct answer: B — Adrenaline 1 mg IV

PEA is a non-shockable rhythm (electrical activity without mechanical output). DO NOT defibrillate. Management: CPR + adrenaline 1 mg IV every 3-5 minutes + aggressively seek and treat reversible causes. The most important aspect of PEA management is identifying the cause: massive PE → thrombolysis, tension pneumothorax → needle decompression, tamponade → pericardiocentesis, hypovolaemia → fluids. PEA with a narrow QRS suggests a mechanical cause.

Reference: ARC/ANZCOR – 2024 – ALS Guidelines