Question

After initiation of CPR and 1 shock for ventricular fibrillation, this rhythm is present on the next rhythm check. A second shock is given, and chest compressions are resumed immediately. An IV is in place, and no drugs have been given. Bag-mask ventilations are producing visible chest rise. What is your next intervention?

a)Give epinephrine 1 mg IV/IO
b)Administer 3 sequential (stacked) shocks at 320 J (monophasic defibrillator)
c)Intubate and administer 100% oxygen
d)Give amiodarone 300 mg IV/IO

Answer 1

The next intervention after a second shock for ventricular fibrillation and the resumption of CPR is to administer epinephrine 1 mg IV/IO as per ACLS guidelines to help restore a perfusing rhythm.

Step-by-step explanation:

After the initial shock for ventricular fibrillation and resumption of CPR with adequate ventilation showing visible chest rise, the next intervention should be to administer epinephrine 1 mg IV/IO. In accordance with Advanced Cardiac Life Support (ACLS) guidelines, this drug should be given as soon as possible after defibrillation attempts and continued every 3-5 minutes during the resuscitation process. Administering epinephrine can increase the likelihood of restoring a perfusing rhythm by increasing coronary and cerebral blood flow during CPR.

Stacked shocks and intubation are not immediate next steps in this scenario. Intubation should be considered if bag-mask ventilation is ineffective or if a prolonged resuscitation effort is anticipated, but establishing drug administration is higher priority. After giving the initial dose of epinephrine, if ventricular fibrillation persists, administering amiodarone 300 mg IV/IO should be considered as a next step, but only after epinephrine.