Final answer:
Defibrillation using internal cardiac paddles requires a decrease in energy output setting compared to adhesive gel pads because the internal paddles are closer to the heart and therefore require less energy to achieve defibrillation.
Step-by-step explanation:
When comparing defibrillation using adhesive gel pads with internal cardiac paddles, the correct answer is (C) Decrease in energy output setting. The reason for this is that internal paddles are placed directly on the heart, so less energy is required to achieve the defibrillation effect compared to external pads which have to pass the electrical current through the skin and chest cavity to reach the heart. The conducting gel used with adhesive pads aids in the transfer of energy, reducing resistance and minimizing skin burns, but there is still more tissue for the current to travel through compared to internal paddles. Therefore, with internal paddles, less energy is needed to penetrate the tissues and directly depolarize the cardiac cells, making the defibrillation process more efficient at a lower energy setting.