A 7-year-old child (weight 20 kg) is in pulseless ventricular fibrillation. As per PALS guidelines, what is the correct initial defibrillation energy dose?

• A 4 J/kg (80 J)
• B 10 J/kg (200 J)
• C 360 J (adult dose)
• D 2 J/kg (40 J) ✓

Explanation

PALS guidelines recommend an initial defibrillation dose of 2 J/kg for pediatric VF/pulseless VT. For this 20 kg child, 2 × 20 = 40 J. Subsequent shocks are escalated to 4 J/kg (80 J), and then to 4 J/kg or higher (maximum 10 J/kg, not exceeding 360 J) for refractory VF.

Reference: Ghai Essential Pediatrics, 10th ed.

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