For pulseless sustained VT lasting more than 30 seconds, what is the first-line therapy?

For pulseless sustained VT lasting more than 30 seconds, what is the first-line therapy?

• A. Defibrillation
• B. Synchronized cardioversion
• C. IV fluids
• D. Amiodarone infusion

Answer: (A)

When a ventricular tachycardia presents without a pulse, it is treated as a cardiac arrest rhythm because there is no effective cardiac output. The immediate goal is to reset the heart’s electrical activity as quickly as possible, which is achieved with defibrillation — an unsynchronized shock that stops all electrical activity so a normal rhythm can resume. Synchronized cardioversion is used when VT is present with a pulse, since timing the shock to the heartbeat helps avoid chaotic firing during vulnerable moments. Since there is no pulse here, synchronized shocks wouldn’t be appropriate and could be harmful. IV fluids don’t address the underlying electrical problem and won’t restore a normal rhythm, while amiodarone is useful after initial defibrillation or in refractory cases, not as the first move in a pulseless arrest. After the first shock, continue CPR, administer vasopressors like epinephrine, and reassess; antiarrhythmics can be added if the rhythm recurs or persists.

When a ventricular tachycardia presents without a pulse, it is treated as a cardiac arrest rhythm because there is no effective cardiac output. The immediate goal is to reset the heart’s electrical activity as quickly as possible, which is achieved with defibrillation — an unsynchronized shock that stops all electrical activity so a normal rhythm can resume.

Synchronized cardioversion is used when VT is present with a pulse, since timing the shock to the heartbeat helps avoid chaotic firing during vulnerable moments. Since there is no pulse here, synchronized shocks wouldn’t be appropriate and could be harmful. IV fluids don’t address the underlying electrical problem and won’t restore a normal rhythm, while amiodarone is useful after initial defibrillation or in refractory cases, not as the first move in a pulseless arrest. After the first shock, continue CPR, administer vasopressors like epinephrine, and reassess; antiarrhythmics can be added if the rhythm recurs or persists.