What is the first step in managing cardiac arrest?

• A. Begin high-quality CPR immediately without defibrillation.
• B. Early defibrillation in VF/pVT.
• C. Check for a pulse and wait for orders.
• D. Administer epinephrine first.

Answer: (B)

When a cardiac arrest rhythm is ventricular fibrillation or pulseless ventricular tachycardia, the action with the greatest immediate impact is delivering a defibrillating shock as soon as a defibrillator is available. A shock can reset the heart’s electrical activity and restore a perfusing rhythm, which saves time and dramatically improves survival chances. While you perform CPR to maintain circulation and minimize pauses, you don’t delay defibrillation to check for a pulse or wait for orders if a shockable rhythm is present. If the rhythm isn’t shockable, the approach changes, but for a shockable rhythm the first priority is early defibrillation.