Refractory VF (≥3 shocks): give amiodarone, and consider a vector change (move pads to anterior–posterior) or double sequential external defibrillation. Reassess the H's & T's.
Amiodarone
Refractory VF — after 2nd–3rd shock
IV push · Follow 20 mL NS flush · Can repeat 150 mg once
Lidocaine
Alternative to amiodarone
1–1.5 mg/kg IV push · Repeat 0.5–0.75 mg/kg q5–10 min · Max 3 mg/kg
Magnesium Sulfate
Torsades de Pointes
2 g IV
For TdP or suspected hypomagnesaemia · Push over 1–2 min
Resuscitation adjuncts
1 mEq/kg IV · TCA OD, severe acidosis (pH <7.1), hyperkalaemia
0.5–1 g/kg IV · Confirmed or suspected hypoglycaemia
Calcium Chloride 10%
1 g IV
Hyperkalaemia · Ca-channel blocker OD · Hypocalcaemia