During resuscitation of a cardiac arrest victim, peripheral IV cannulation has failed twice and central access is not immediately available. The next best step for drug delivery according to current guidelines is:

• A Intramuscular adrenaline into the deltoid while continuing CPR
• B Deferring all drugs until venous access is secured
• C Instillation of drugs down the endotracheal tube at double the IV dose
• D Insertion of an intraosseous needle, typically into the proximal tibia ✓

Explanation

When IV access fails, intraosseous access via the proximal tibia, distal tibia, or humeral head is the recommended route, with comparable drug levels and time to delivery as IV. Endotracheal drug delivery produces unpredictable plasma concentrations and is discouraged, killing option C. Intramuscular adrenaline is a lay-rescuer anaphylaxis route, not an arrest route, and deferring drugs costs critical time.

Reference: AHA Guidelines for CPR and Emergency Cardiovascular Care, 2020 ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.