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Refractory VF drug sequence — DipIMC MCQ

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ModerateResuscitationRefractory VF drug sequenceDipIMC

A 51-year-old man in cardiac arrest has persistent VF after five shocks. He has already received adrenaline and amiodarone 300 mg after the third shock. What is the most appropriate drug/dose?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Amiodarone 150 mg IV after the fifth shock

In refractory VF or pulseless VT, amiodarone 300 mg is given after the third shock and a further 150 mg after the fifth shock. Adenosine and atropine are not treatments for refractory VF arrest. Magnesium is reserved for torsades de pointes or specific indications rather than routine VF. The pearl is to combine drug therapy with pad position, compression quality and reversible-cause review.

Reference: Resuscitation Council UK Adult ALS Guidelines 2025