Question

A patient is in refractory ventricular fibrillation. High-quality CPR is in progress. One dose of epinephrine was given after the second shock. An antiarrhythmic drug was given immediately after the third shock. You are the team leader. Which medication do you order next?

A) Epinephrine 1 mg
B) A second dose of the antiarrhythmic drug
C) Epinephrine 3 mg
D) Sodium bicarbonate 50 mEq

Answer 1

In a case of refractory ventricular fibrillation with CPR in progress, after one dose of epinephrine and an antiarrhythmic drug have been given, the team leader should next order another dose of Epinephrine 1 mg as per ACLS guidelines.

Step-by-step explanation:

The patient you described is in refractory ventricular fibrillation, which is a critical condition where the heart exhibits rapid, erratic electrical activity, making it unable to pump blood effectively. Due to the administration of epinephrine after the second shock and an antiarrhythmic after the third shock without successful conversion to a stable rhythm, you should typically consider another dose of epinephrine.

According to Advanced Cardiac Life Support (ACLS) guidelines, epinephrine should be given every 3-5 minutes during cardiac arrest. As a team leader in this scenario, the next medication to order would be Epinephrine 1 mg, which aligns with option A. The choice to administer additional antiarrhythmic drugs or other medications like sodium bicarbonate would be based on the specific clinical circumstances and guidance from current ACLS protocols.