ACLS Megacode 6: Syncope/Pulseless Electrical Activity

76 y/o F collapses and brought immediately to the emergency department by bystanders.

On arrival, she is placed on monitor and the following rhythm is seen:

You cannot palpate a pulse.

The patient remains in the below rhythm and is without a pulse.

You have performed round of CPR.

While you are continuing CPR/ACLS, staff asks you for possible causes of PEA arrest.

On the next rhythm check, the patient demonstrates the following rhythm:

She now has a palpable pulse but is hypotensive, unresponsive, and hypoxic.

After cardioverting and intubating, you get an EKG which demonstrates the following:

You re-assess the patient and cannot palpate a pulse.