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Hypovolaemic cardiac arrest — DipIMC MCQ

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ModerateResuscitationHypovolaemic cardiac arrestDipIMC

A 70-year-old woman has pulseless electrical activity after massive haematemesis. She has no signs of chest trauma and bystanders report black stools for two days. What is the most appropriate management?

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Correct answer: B — Continue ALS while prioritising haemorrhage control and blood product activation through pre-alert

PEA after major gastrointestinal bleeding is likely severe hypovolaemia, so ALS should run in parallel with rapid activation of haemorrhage pathways. Defibrillation is not indicated for PEA. Crystalloid alone is not definitive resuscitation for major haemorrhage and can worsen dilutional coagulopathy. The pearl is that ALS in hypovolaemic arrest succeeds through treating the cause, not through compressions alone.

Reference: Resuscitation Council UK Adult ALS Guidelines 2025; JRCALC Guidelines 2025