What should be done if defibrillation terminates PVT but the patient returns to PVT?

When a patient returns to pulseless ventricular tachycardia (PVT) despite initial defibrillation attempts, it's crucial to use the same energy setting that was previously effective. By defibrillating at the last successful energy setting, you're optimizing the chances of restoring a normal heart rhythm because this energy level was specifically chosen based on its effectiveness in a previous attempt.

Defibrillation aims to disrupt the abnormal electrical circuit causing the arrhythmia, and starting at the previously successful setting gives the best chance of terminating the PVT again. This approach is consistent with advanced cardiac life support (ACLS) guidelines, which recommend using previously effective settings when faced with recurrent arrhythmia episodes.

In cases where the energy setting is altered, there might be an increased risk of poor outcomes or failure to sync effectively with the heart's rhythm. Immediate CPR or other interventions may be necessary in some contexts, but focusing on the last successful energy setting for defibrillation directly addresses the critical need to revert the heart rhythm effectively.