Which medication is the first one administered to a patient with pulseless electrical activity (PEA)?

• A. Epinephrine (Adrenalin)
• B. Amiodarone
• C. Atropine
• D. Adenosine

Answer: (A)

In pulseless electrical activity, the heart has electrical activity but is not producing a palpable pulse due to very poor cardiac output. The highest priority is to restore perfusion with effective CPR and a medication that boosts perfusion pressures during CPR. Epinephrine is the first-line drug because its alpha-adrenergic effects raise systemic vascular resistance and increase aortic diastolic pressure, which improves coronary and cerebral perfusion during chest compressions. This helps create the conditions for returning spontaneous circulation while you address reversible causes.

Dosing typically is 1 mg IV every 3-5 minutes during the arrest. Amiodarone is reserved for shockable rhythms like VF/VT, not for PEA. Adenosine is used for specific stable tachycardias, not in arrest. Atropine is not a first-line treatment for PEA in modern ACLS guidelines.