A 48-year-old woman on maintenance haemodialysis suffers an in-hospital cardiac arrest. Monitor shows PEA with wide QRS complexes. She was noted earlier to have tall tented T waves. Alongside standard ACLS, the MOST specific additional treatment is:

• A Atropine 1 mg IV
• B Calcium chloride 10 mL of 10% solution IV ✓
• C Amiodarone 300 mg IV bolus
• D Magnesium sulphate 2 g IV

Explanation

Wide complex PEA in a dialysis patient with peaked T waves points strongly to life threatening hyperkalemia as the reversible cause. Calcium chloride (or calcium gluconate) stabilises the myocardial membrane and is the specific antidote, followed by insulin-dextrose and sodium bicarbonate. Amiodarone treats shock refractory VF and pulseless VT, magnesium treats torsades de pointes, and atropine has no role in arrest. Treating the underlying potassium derangement offers the only realistic route to ROSC here.

Reference: AHA Guidelines for CPR and Emergency Cardiovascular Care, 2020 ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.