In a patient with ventricular fibrillation who has an implanted defibrillator, what is the recommended immediate intervention?

• A. Remove the implanted defibrillator and perform external chest compressions only.
• B. Place external pads on the chest without skin contact.
• C. Delay defibrillation to obtain a rhythm strip.
• D. Apply hands-free anterior-posterior patches and deliver a shock.

Answer: (D)

The priority in ventricular fibrillation is immediate defibrillation to terminate the chaotic electrical activity and restore a perfusing rhythm. When a patient has an implanted defibrillator, you still deliver external defibrillation, but you must place the pads so the current path avoids directly striking the device and goes through the heart effectively. Using hands-free anterior-posterior pads achieves this: one pad placed on the chest and the other on the back to direct energy through the heart while keeping the implanted generator out of the direct pad field. Delivering the shock promptly is essential; delaying to obtain a rhythm strip wastes critical time, and attempting external compression only while removing the device is not appropriate. Pads must be in contact with skin to deliver the energy.