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    14 year-old girl, pulseless, CPR ongoing

    By   ·  1 minute read

    A 14 yo girl presents to the ED after collapsing at a basketball game. She was found to be pulseless, and CPR is ongoing.  An intraosseous line is in place. You put her on monitors and see the following rhythm: 

    image (14)

    Pediatric Emergency Medicine, 3rd Edition, ECG courtesy of Dr. Rebekah Burns

    You cannot feel a pulse. After resuming chest compressions, which of the following should be administered?

    • Lidocaine loading dose
    • Normal saline bolus
    • IV/IO epinephrine
    • Shock of 2J/kg
    The correct answer is:

    IV/IO epinephrine

    IV/IO epinephrine. The patient has pulseless electrical activity (PEA). For patients with non-shockable rhythms such as PEA or asystole, the earlier epinephrine is administered after CPR initiation, the more likely the patient is to survive. A normal saline bolus may be indicated during resuscitation of this patient, but epinephrine should not be delayed. Lidocaine is not indicated for PEA. PEA is a non-shockable rhythm so administering a shock of 2J/kg is not recomended. [Topjian 2020; F&L pp 44-71]

     

    This question appears in Med-Challenger Pediatric Emergency Medicine Exam Review with CME - 3rd Edition.

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