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PEA with hyperkalaemia — DIPIMC MCQ

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HardResuscitationPEA with hyperkalaemiaDIPIMCDipIMC

A patient on chronic haemodialysis who missed a session is found in cardiac arrest. The rhythm is a broad-complex, slow pulseless electrical activity, and a recent ECG strip shows tall, tented T waves and a widened QRS. CPR and adrenaline are under way. Which additional treatment most directly addresses the likely cause?

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Correct answer: E — Intravenous calcium chloride to stabilise the myocardium

The clinical picture points to severe hyperkalaemia, and intravenous calcium chloride is given first to stabilise the myocardium against the effects of a high potassium, in addition to high-quality CPR and adrenaline. Measures to shift potassium intracellularly, such as insulin with glucose and salbutamol, follow. Cardioversion does not treat pulseless electrical activity, and a fluid challenge does not correct the underlying problem. Pearl: hyperkalaemia is a key reversible cause to consider in any dialysis patient who arrests.

Reference: Resuscitation Council UK Guidelines 2025 (Special Circumstances)