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A 45 years old man with chest pain which has been started from 1 hour ago with sweating and nausea came to ED, during ECG, patient lost his cosciousness and became cyanotic, his ECG showed ventricular fibrillation.what is your first action for controlling of arrhythmia?
A. IV lidocaine
B. 200 J DC shock
C. IV brithilium
D. external pace maker installation


When your read the ACLS book everything looks nice and logical. But when you get a question like this you just wonder: Damn!! Debrifrillation or Drugs? Which one first?

Well, let me tell you according to the ACLS book I have (page 1-19), it says that and I quote "If VF/VT persists after basic CPR, intubation, ventilation, four defibrillations, and one or more doses of epinephrine, rescuers are dealing with refractory or persistent FV. In addition, minutes have passed during which the patient has likely received only modest blood flow (10%-30% of normal) from conventional closed-chest CPR. The chances now to the patient's regaining spontaneous circulation and succcessful neurological outcome are low. Typically at this point in the protocol, rescuers adminsiter an antifibrillatory agent, such as lidocaine, bretylium, or procainamide. They should follow this within 30 t0 60 seconds with a 360 J shock. Rescuers must undersand that it is not the pharmacologic agent that defibrillates the heart but the direct current shock.....bla....bla".

So basically B would be the answer. Lidocaine or bretillium comes next if unsuccessful.


Agree with B.

Also , as per my knowledge, Bretylium is not between 1st line anthyarrithmics for rx of Vfib, if at all is used nowdays. There are other meds :

Amiodarone, Lidocaine , add Mg.

Bretyllium can cause severe hypotension.


Shock him like no other, time to defib that v. fib


No time, DC Shock is the action!




B is the correct answer

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