During PALS resuscitation of a 5-year-old in pulseless ventricular fibrillation (VF), the first shock at 2 J/kg fails to convert. After a 2-minute CPR cycle, VF persists. Epinephrine has been given. Which is the CORRECT dosing and timing for amiodarone in this context?
- A Amiodarone 5 mg/kg IV/IO, can repeat once after next CPR cycle ✓
- B Amiodarone 3 mg/kg IV/IO bolus, maximum 2 doses
- C Amiodarone 1 mg/kg IV/IO, followed by infusion 5 mcg/kg/min
- D Amiodarone 5 mg/kg IV/IO only after third defibrillation attempt
Explanation
Per current PALS guidelines (AHA 2020), amiodarone is given for shock-refractory VF/pulseless VT at a dose of 5 mg/kg IV/IO bolus, which may be repeated up to twice (maximum 3 doses / 15 mg/kg total). It is given after the third shock (i.e., after the second CPR cycle post-first shock), along with or after epinephrine. Lidocaine 1 mg/kg is an alternative. The 3 mg/kg dose is not a standard PALS dose. Amiodarone is not restricted to after the third defibrillation — it is first given after the third shock in the algorithm but the question asks about dosing, where 5 mg/kg with one repeat is correct.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.