Before giving antiarrhythmic medication to a child with pulseless ventricular tachycardia, what is the recommended initial intervention?

• A. Administer defibrillator pads and give epinephrine
• B. Administer amiodarone immediately
• C. Defibrillate
• D. Start external pacing

Answer: (C)

In a child with pulseless ventricular tachycardia, the rhythm is a shockable arrest rhythm, so the priority is to deliver a defibrillating shock promptly to try to restore a perfusing rhythm. Defibrillation should occur before giving antiarrhythmic medications because shocking can quickly halt the chaotic electrical activity and regain circulation, whereas medications take time to work and may delay the essential shock. After a shock (or after initial shocks if the rhythm persists), follow with CPR and epinephrine at recommended intervals; antiarrhythmics like amiodarone are considered after sustained failures of defibrillation. External pacing is not the immediate step here, as pulseless VT is best addressed with defibrillation first.