Which statement best describes the initial management of ventricular fibrillation with no pulse?

• A. The patient is stable; observe
• B. The patient is in myocardial infarction; treat with nitroglycerin
• C. Immediate defibrillation and CPR
• D. Immediate thrombolysis

Answer: (C)

When a patient is in ventricular fibrillation with no pulse, the priority is to restore a perfusing rhythm as quickly as possible. VF is an electrical chaos that cannot be corrected with medications alone in the moment; the only rapid way to terminate it is an external defibrillating shock. While the shock is being prepared and delivered, high-quality CPR is started immediately to maintain organ perfusion and buy time for the rhythm to convert.

Observing the patient offers no therapeutic benefit in this arrest scenario. Nitroglycerin is used for certain types of chest pain or stable myocardial ischemia, not for pulseless cardiac arrest. Thrombolysis is aimed at dissolving clots in a STEMI context and is not the immediate treatment for a VF arrest; delaying defibrillation to give thrombolytics would worsen outcomes. The combination of immediate defibrillation with concurrent CPR provides the best chance of survival and neurologic outcome in this situation.