A 6-year-old child (weight 20 kg) is in ventricular fibrillation. The appropriate defibrillation energy for the first shock is:

• A 100 J
• B 200 J (adult default)
• C 360 J
• D 50 J ✓

Explanation

Pediatric defibrillation is dosed at 2 J/kg for the first shock, followed by 4 J/kg for subsequent shocks. For a 20 kg child, the initial dose is 2 × 20 = 40 J, and 50 J is the closest reasonable answer representing the practical delivery approximation. Adults receive 200 J (biphasic) or 360 J (monophasic). Pediatric paddles (4.5 cm diameter) are used for children under 10 kg or under 1 year; adult paddles (8–12 cm) are used for larger children.

Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.

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