What is the immediate action for a patient with pulseless VT or VF on ECG?

• A. Begin ACLS with immediate defibrillation as indicated
• B. Start IV fluids and watch
• C. Administer nitroglycerin
• D. Vagal maneuvers

Answer: (A)

Immediate defibrillation is needed because pulseless ventricular tachycardia and ventricular fibrillation are shockable rhythms that prevent any effective cardiac output. Delivering an unsynchronized shock briefly depolarizes the myocardium, interrupting the chaotic electrical activity and allowing the heart to reestablish an organized rhythm. In ACLS, this shock is given as soon as the rhythm is identified, then CPR is started or resumed without delay, followed by rhythm checks and subsequent steps as indicated.

The other options don’t address the life-threatening rhythm: IV fluids and watching do not treat a nonperfusing rhythm, nitroglycerin is used for chest pain or ischemia with a pulse, and vagal maneuvers are not effective for pulseless VT/VF.