During resuscitation of a 7-year-old in pulseless ventricular fibrillation (VF), after the first shock at 2 J/kg without return of spontaneous circulation, what is the correct next shock energy?

• A 4 J/kg ✓
• B 2 J/kg again
• C 10 J/kg
• D 360 J (monophasic maximum)

Explanation

Per PALS protocol for pediatric defibrillation, the first shock is 2 J/kg; if VF persists, the second and subsequent shocks are 4 J/kg (maximum 10 J/kg or adult maximum, whichever is lower). The step-up from 2 to 4 J/kg follows immediately after two minutes of CPR post-shock. Using adult maximum energies initially risks myocardial injury in a child.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.