When attempting resuscitation of a child with pulseless electrical activity, you should:

• A. Attempt to identify an underlying cause of the arrest.
• B. Immediately start defibrillation.
• C. Administer high-dose epinephrine every 3 minutes.
• D. Pause CPR and observe.

Answer: (A)

Pulseless electrical activity is when there is electrical activity on monitors but the heart is not pumping effectively. The key in pediatric resuscitation is to continue high-quality CPR while rapidly identifying and correcting reversible causes that could be preventing the heart from generating a pulse. In children, PEA is commonly linked to problems such as hypoxia, hypovolemia, metabolic or electrolyte disturbances, toxins, or mechanical issues like tamponade or tension pneumothorax. By quickly pinpointing and treating these reversible factors—airway and ventilation optimization, fluid resuscitation for dehydration or bleeding, correcting acidosis or electrolyte imbalances, and addressing mechanical problems—you give the heart a better chance to regain effective contractions.

Defibrillation isn’t appropriate here because the rhythm is non-shockable, meaning there’s no organized ventricular rhythm to convert with a shock. Epinephrine should be given during CPR at standard intervals rather than as a high-dose, and you should not pause CPR to observe; the focus remains on continuous chest compressions while you search for and fix reversible causes.