A 9-year-old patient with known familial dilated cardiomyopathy is in the PICU receiving a milrinone infusion and awaiting a heart transplant. Suddenly she becomes unresponsive and is found to be pulseless. The following rhythm strip is seen:
Which of the following is the BEST next step?
a) Epinephrine 1:10,000 dilution, 10mcg/kg IV
b) Synchronized cardioversion at 0.5 J/kg
c) Defibrillation at 2 J/kg
d) Defibrillation at 4 J/kg
e) Synchronized cardioversion at 1 J/kg
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Answer
Answer C.
The immediate treatment for pulseless ventricular fibrillation is defibrillation with an initial 2 J/kg. Importantly, CPR should also be initiated pending availability/arrival of a cardiac defibrillator and should continue until the device is charged and ready to shock.
