Final answer:
The recommended next step for a patient in ventricular fibrillation after 1 shock and 2 minutes of CPR is to administer epinephrine and continue high-quality CPR. Synchronized cardioversion is not indicated in this scenario.
Step-by-step explanation:
If a patient remains in ventricular fibrillation despite one shock and two minutes of continuous CPR, the recommended next step according to the Advanced Cardiac Life Support (ACLS) guidelines is to administer a dose of epinephrine. It is critical to continue high-quality CPR without unnecessary interruptions, even after the medication is administered, and then proceed according to the ACLS algorithm, which may include additional defibrillation attempts and administration of other medications such as amiodarone if the arrhythmia persists. Synchronized cardioversion, on the other hand, is not indicated in ventricular fibrillation because this arrhythmia does not have organized electrical activity that can be synchronized.