Ventricular fibrillation with no pulse requires which initial steps?

• A. Synchronized cardioversion
• B. Observation and oxygen
• C. Amiodarone infusion
• D. Defibrillate (unsynchronized) + CPR

Answer: (D)

In pulseless ventricular fibrillation, the priority is to restore a perfusing rhythm with immediate defibrillation and continued CPR. The heart is in chaotic, rapid electrical activity, so there’s no organized contraction to produce a pulse. An unsynchronized shock (defibrillation) aims to reset the electrical activity of the heart, giving it a chance to restart a normal rhythm. After delivering the shock, high-quality CPR is performed to maintain blood flow while the heart regains an organized rhythm.

Synchronized cardioversion is intended for tachyarrhythmias with a pulse, not for a cardiac arrest rhythm without a pulse. Observation and giving oxygen do not address the underlying problem in arrest. Amiodarone can be used after an initial shock if the rhythm persists, but it’s not the first step in pulseless VF.