PEA Arrest and Breaking Bad News

This case was written by Dr. Alexandra Stefan. Dr. Stefan (@astefan12) is an emergency physician at Sunnybrook Health Sciences Centre and University Health Network, and assistant professor in the Division of Emergency Medicine, University of Toronto. She is the Co-Director of Postgraduate Education in the Sunnybrook Emergency Department. Her interests include physician wellness, medical education, global health education, and she has been faculty for several teaching trips with the Toronto Addis Ababa Academic Collaboration. She believes that simulation is valuable education tool for health care providers to develop and practice a broad range of clinical skills, from ACLS to goals of care discussions.

Why It Matters

Cardiac arrest management is a core competency in emergency medicine. Unfortunately, the outcome is not always what we hope for. Navigating communication with family members, goals of care, and breaking bad news can be even more challenging than managing the cardiac arrest itself. This case gives a chance to manage a PEA arrest from EMS arrival through to breaking bad news.

Clinical Vignette

Patient found vital signs absent (VSA) in change room of tennis club. Bystander CPR was initiated post 911 call, but down time is unclear. BLS crew arrived on scene, continued CPR and transported to the ED. There have been five ‘no shock advised’ for a total transport time of 10 min. The patient arrives in the ED with BVM, CPR in progress. No IV established. No pulse.

Case Summary

A 70 year old man who had an unwitnessed cardiac arrest is brought to the ED via EMS from his local Tennis Club. Despite multiple rounds of appropriate resuscitative measures, the patient does not gain return of spontaneous circulation (ROSC). Learners will need to discuss the termination of resuscitation with team members and communicate with the patient’s wife.

Download the case here: Breaking Bad News

Ultrasound for the case found here:

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One thought on “PEA Arrest and Breaking Bad News

  1. Excellent Sim case – thank you.
    Too often we teach student how to resuscitate a patient but this does not usually include taking the family on the journey of delivering poor outcomes


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