Advanced Cardiovascular Life Support (ACLS) Practice Exam

After the second shock in a patient with refractory ventricular fibrillation, what should the team leader prepare next?

1. Second dose of adenosine

2. Second dose of epinephrine 1 mg

3. Amiodarone 150 mg

4. Magnesium sulfate

The correct answer is: Second dose of epinephrine 1 mg

In the context of managing a patient with refractory ventricular fibrillation, the administration of epinephrine is essential following the second shock. This is because epinephrine increases coronary perfusion pressure and enhances the likelihood of achieving return of spontaneous circulation (ROSC). The standard protocol during continuous resuscitation efforts calls for administering epinephrine every 3-5 minutes, thus making it a critical next step after each shock in cases where the patient remains in cardiac arrest. In the setting of refractory ventricular fibrillation, the use of epinephrine is prioritized to improve hemodynamics and support the heart's ability to respond to subsequent shocks and medications effectively. While other medications like amiodarone play a role in managing ventricular fibrillation, especially if it is persistent, they are not initiated immediately after the second shock in this sequence of treatment. The correct choice emphasizes adhering to established resuscitation guidelines that recommend epinephrine after shocks in an attempt to stabilize the cardiovascular status of the patient before considering additional antiarrhythmic agents.