In a patient with pulseless ventricular tachycardia, what is the recommended sequence of actions?

• A. CPR, epinephrine, then defibrillation
• B. Defibrillation (unsynchronized shock), CPR, then epinephrine every 3–5 minutes; consider amiodarone if refractory
• C. Defibrillation, then aspirin, then CPR
• D. Amiodarone first, then CPR

Answer: (B)

In a patient with pulseless ventricular tachycardia, the priority is a shockable rhythm, so defibrillate as soon as possible. An unsynchronized shock aims to terminate the tachyarrhythmia and allow the heart to regain a perfusing rhythm. After the first defibrillation, start high-quality CPR immediately to maintain cerebral and coronary perfusion while the rhythm is being treated and reassessed.

Epinenrine is given during CPR at intervals of every 3–5 minutes to increase coronary and cerebral perfusion pressures, helping the likelihood of return of spontaneous circulation. If the rhythm remains refractory to shocks—meaning VT/VF persists after successive defibrillations—an antiarrhythmic like amiodarone is added to improve the chance of a successful termination and reduce recurrence.

Aspirin isn’t part of the acute resuscitation sequence for pulseless VT, and giving it would delay critical interventions. If ROSC is achieved, shift focus to post-arrest care.