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Pulseless electrical activity from hyperkalaemia — DipIMC MCQ

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HardResuscitationPulseless electrical activity from hyperkalaemiaDipIMC

A 55-year-old dialysis patient collapses at home after missing two sessions. He is pulseless with organised broad-complex electrical activity, end-tidal CO2 1.2 kPa during CPR, and the monitor shows sine-wave morphology. What is the most appropriate management?

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Correct answer: E — Treat hyperkalaemia with IV calcium while continuing ALS

The rhythm and history strongly suggest hyperkalaemic PEA, so ALS should continue with immediate calcium to stabilise the myocardium and specific hyperkalaemia therapy according to capability. Broad complexes are not a shockable rhythm unless VF or pulseless VT is present. Waiting for laboratory confirmation delays treatment of a reversible cause.

Reference: Resuscitation Council UK Special circumstances 2025; JRCALC Guidelines