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A 12-month-old 10 kg male is undergoing repair of VSD. Separation from CPB
is underway and the child’s ECG demonstrates a chaotic, uncoordinated rhythm,
with a decrease in cerebral oximetry and systemic blood pressure. The next
appropriate step in management would be:

a) Temporary pacing at 140 bpm

b) Atropine 200 mcg IV bolus

c) Immediate defibrillation with internal pads

d) Epinephrine 10 mcg IV bolus

e) Restarting CPB



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==Answer==
Answer c. 

The ECG suggests ventricular fibrillation, and the definitive treatment
for this rhythm is immediate defibrillation. Internal paddles, or externally
applied pads may be used. Epinephrine at 10 mcg/kg and resuming CPB may be
considered in the management algorithm, but will not solve the underlying
dysrhythmia. Temporary pacing is inappropriate, as is atropine use in this
setting.


==Notes==
<references />
:This question originally printed in the [http://www.amazon.com/Justin-L.-Lockman/e/B00FLG5AEE/ref=ntt_dp_epwbk_0 Pediatric Anesthesiology Review Topics] kindle book series, and appears courtesy of Naerthwyn Press, LLC.

==Keywords==
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