During resuscitation of a 5-year-old who is apneic and pulseless with ventricular fibrillation on the monitor, what is the correct action?

• A. Defibrillate with 40 joules and immediately resume CPR.
• B. Deliver shock with 200 joules and omit CPR.
• C. Call for help and wait for pads.
• D. Begin chest compressions only.

Answer: (A)

In a child with a pulseless arrest and a shockable rhythm like ventricular fibrillation, the priority is to terminate the arrhythmia with defibrillation and then immediately restart high-quality CPR. Defibrillation delivers a brief electrical shock that can reset the heart’s electrical activity and restore a perfusing rhythm; however, the heart often needs continued perfusion through CPR right after the shock to support organs while the rhythm stabilizes. For pediatric defibrillation, energy is dosed by weight (about 2 J/kg initially, up to 4 J/kg for subsequent shocks). For a typical 5-year-old, that energy commonly falls around 40 J, which is a standard pediatric setting on many devices, and it’s acceptable to use that amount when weight is not precisely known. Deliver the shock and then resume CPR immediately rather than waiting or delaying to place pads or to reassess. The other approaches would either delay the essential shock, omit CPR after the shock, or treat the situation as non-shockable, which would miss the opportunity to reverse VF and preserve circulation.