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Nursing QUESTION #9238
Question 1
A patient develops Ventricular Fibrillation (VF) in the ICU. According to ACLS 2020 guidelines, what is the CORRECT sequence of management?
  • Defibrillate 360J → Amiodarone 300mg → CPR 2 min → Epinephrine 1mg
  • CPR 2 min → Defibrillate 200J biphasic → Epinephrine 1mg → CPR 2 min → Amiodarone if VF persists
  • Defibrillate immediately → CPR 2 min → Epinephrine 1mg IV → CPR 2 min → Amiodarone 300mg if VF/pVT persists✔️
  • Epinephrine 1mg → CPR 5 min → Defibrillate 360J → Amiodarone 150mg
Correct Answer Explanation
Correct Answer: C — ACLS VF/pulseless VT Algorithm (2020)

ACLS Shockable Rhythm (VF/pVT) Algorithm:
  1. Defibrillate immediately (biphasic 120–200J; monophasic 360J)
  2. CPR 2 minutes (high-quality: 100–120 compressions/min, depth \(5-6 \text{ cm}\))
  3. Check rhythm — if still VF/pVT:
  4. Epinephrine 1 mg IV/IO every 3–5 minutes
  5. Defibrillate again
  6. CPR 2 minutes
  7. If VF/pVT persists: Amiodarone 300 mg IV (second dose: 150 mg) OR Lidocaine
Key points:
  • Minimize interruptions in CPR (pause \(< 10\) seconds for shocks)
  • Treat reversible causes: 5 H's and 5 T's (Hypoxia, Hypovolemia, H\(^+\) acidosis, Hypo/Hyperkalemia, Hypothermia; Tension pneumothorax, Tamponade, Toxins, Thrombosis-PE, Thrombosis-coronary)
  • Epinephrine: given after first or second defibrillation attempt, then every 3–5 min