Question

A patient presents with no pulse, and the ECG shows the following rhythm. What is the next appropriate step? 

• A. Defibrillate, check pulse and then perform CPR
• B. Cardioversion
• C. Defibrillate, perform CPR, and then check the pulse
• D. Administer epinephrine

Hint:

In the case of ventricular fibrillation, defibrillation followed by CPR is the most effective initial management to restore circulation and save the patient’s life.

Answer 1

The Correct Option is C

Step 1: Classify the cardiac arrest.
A pulseless patient whose monitor shows ventricular fibrillation or pulseless ventricular tachycardia is in a SHOCKABLE rhythm. The ACLS arrest algorithm splits sharply here: shockable rhythms get electricity first, non-shockable rhythms (asystole/PEA) get drugs and compressions only.

Step 2: Decide shock versus synchronised cardioversion.
Cardioversion is synchronised to the R wave and is reserved for unstable patients who still have a pulse. A pulseless arrest has no organised QRS to synchronise to, so the correct electrical therapy is unsynchronised DEFIBRILLATION, not cardioversion.

Step 3: Order the actions correctly.
Per ACLS for a shockable rhythm: deliver one shock immediately, then resume chest compressions (CPR) at once for a full 2-minute cycle, and ONLY after those 2 minutes pause to reassess the rhythm and pulse. You do not stop to feel for a pulse right after the shock $-$ that wastes perfusion time.

Step 4: Test each option against this sequence.
$\bullet$ Defibrillate $\rightarrow$ check pulse $\rightarrow$ CPR: wrong, the pulse check is wrongly inserted before CPR.
$\bullet$ Cardioversion: wrong, no pulse to synchronise.
$\bullet$ Administer epinephrine: a drug, but in a shockable rhythm the shock comes first.
$\bullet$ Defibrillate $\rightarrow$ CPR $\rightarrow$ check the pulse: matches the algorithm exactly.

Step 5: Conclusion.
The correct next step is to defibrillate, immediately perform CPR for 2 minutes, and then check the pulse/rhythm.

Final answer: Option 3 - Defibrillate, perform CPR, and then check the pulse.