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Refractory ventricular fibrillation — DipIMC MCQ

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ModerateResuscitationRefractory ventricular fibrillationDipIMC

A 59-year-old man in cardiac arrest remains in ventricular fibrillation after three shocks. Chest compressions are ongoing, vascular access is established and the team is preparing for the next cycle. What is the most appropriate drug/dose?

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

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Correct answer: E — Adrenaline 1 mg IV and amiodarone 300 mg IV after the third shock

For shockable cardiac arrest, adrenaline and amiodarone are given after the third shock while CPR continues. Adrenaline before the third shock is not the usual ALS sequence for VF or pulseless VT. Calcium is reserved for specific causes such as hyperkalaemia, hypocalcaemia or calcium-channel blocker overdose. The pearl is that drug timing should fit the defibrillation cycle without interrupting compressions.

Reference: Resuscitation Council UK Adult ALS Guidelines 2025