You are on the scene of a 55-year-old male in cardiac arrest. His initial rhythm was ventricular fibrillation. You have delivered three shocks at 200, 300, and 360 joules. The patient remains in ventricular fibrillation. Which of the following sequences of intervention is best?
A) Ventilate by bag-valve-mask with supplemental oxygen and an oropharyngeal airway in place, perform chest compressions, start an IV of normal saline with a large bore catheter, administer 1 mg of 1:10,000 epinephrine, IV push; continue CPR for an additional minute and defibrillate at 360 joules.
B) Ventilate by bag-valve-mask with supplemental oxygen and an oropharyngeaol airway in place, perform chest compressions, start an IV of normal saline with a large bore catheter, administer 100 mg of lidocaine intravenously; continue CPR for an additional minute and defibrillate at 360 joules up to three times.
C) Intubate the trachea, ventilate by bag-valve device using supplemental oxygen, perform chest compressions, administer 2 mg epinephrine endotracheally and ventilate vigorously to aerosolize the medication; defibrillate up to three times at 360 joules.
D) Ventilate by bag-valve-mask with supplemental oxygen and an oropharyngeal airway in place; perform chest compressions; start an IV of normal saline with a large bore catheter; administer 1 mg of 1:1000 epinephrine, IV push; continue CPR for an additional minute and defibrillate at 360 joules.
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