During PALS resuscitation, a pulseless 8-year-old with ventricular fibrillation on cardiac monitor receives two unsuccessful defibrillation attempts. What is the recommended defibrillation energy dose in pediatric VF/pulseless VT per PALS 2020 guidelines?
- A 2 J/kg for first shock, 4 J/kg for subsequent shocks (up to 10 J/kg or adult dose) ✓
- B 1 J/kg for first shock, 2 J/kg for subsequent shocks
- C 5 J/kg for all shocks regardless of prior attempts
- D 360 J (adult dose) for all pediatric VF regardless of weight
Correct answer: A. 2 J/kg for first shock, 4 J/kg for subsequent shocks (up to 10 J/kg or adult dose)
Explanation
PALS 2020 guidelines recommend 2 J/kg for the first defibrillation attempt in pediatric VF/pulseless VT, followed by 4 J/kg for subsequent shocks, increasing up to a maximum of 10 J/kg or the adult dose (200–360 J), whichever is lower. The escalating energy protocol improves chances of successful termination with repeated shocks. Using adult doses in small children risks myocardial injury, while underdosing fails to achieve successful defibrillation.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.