Advanced Cardiovascular Life Support (ACLS) Practice Exam

A patient remains in ventricular fibrillation despite 1 shock and 2 minutes of continuous CPR. What is the next intervention?

1. Administer a second shock

2. Continue CPR for another 5 minutes

3. Check for a pulse

4. Administer antiarrhythmic medication

The correct answer is: Administer a second shock

In the scenario where a patient remains in ventricular fibrillation after one shock and two minutes of continuous CPR, the best next intervention is to administer a second shock. This approach is consistent with current advanced cardiovascular life support (ACLS) guidelines, which emphasize that after the initial shock, immediate high-quality CPR is essential, followed by reassessment and shock delivery as necessary. Delivering a second shock quickly is crucial because ventricular fibrillation is a shockable rhythm, and the chances of restoring a normal heart rhythm diminish over time. Administering another shock allows the defibrillator to attempt to reset the electrical activity of the heart again and may restore an effective rhythm. It is vital to maintain the sequence of rhythm assessment, shock where applicable, and CPR—a sequence designed to maximize the chances of survival. Continuing CPR for another five minutes before reassessing or shocking can lead to unnecessary delays in re-establishing a normal rhythm. Checking for a pulse at this stage would not be beneficial since the patient is in ventricular fibrillation, and antiarrhythmic medication is typically administered after more attempts at defibrillation if the rhythm does not convert.