The approach in Advanced Cardiac Life Support provided by the American Heart Association and the European Resuscitation Council guidelines for the management of pulseless electrical activity emphasizes on the search of reversible causes. Tension pneumoperitoneum is an uncommon surgical emergency encountered in the accident and emergency department. We report a case of pulseless electrical activity secondary to tension pneumoperitoneum in an elderly woman. Restoration of spontaneous circulation was immediately achieved after needle decompression. The management of tension pneumoperitoneum is discussed.
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