In a patient with refractory VF despite 3 defibrillations, amiodarone is indicated. The initial IV bolus dose in ACLS is:
- A 150 mg IV over 10 minutes
- B 5 mg/kg IV bolus up to a maximum of 450 mg
- C 300 mg IV bolus, with a second 150 mg bolus if VF persists ✓
- D 1 mg IV bolus repeated every 3–5 minutes (max 3 mg)
Correct answer: C. 300 mg IV bolus, with a second 150 mg bolus if VF persists
Explanation
In refractory VF/pulseless VT, amiodarone 300 mg IV bolus is given after the third defibrillation, followed by CPR and subsequent shock. A second dose of 150 mg IV can be given for recurrent or refractory VF after the fifth shock. Lidocaine is an alternative if amiodarone is unavailable (1.5 mg/kg IV). The 1 mg bolus repeated to 3 mg refers to atropine dosing for bradycardia, not amiodarone. The 150 mg dose over 10 minutes is used for stable VT, not pulseless VF arrest.
Reference: Morgan & Mikhail's Clinical Anesthesiology, 6th ed.
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