The 2025 medical cardiac arrest guidelines were updated to include early administration of amiodarone in patients with Ventricular Tachycardia (VTach) and Ventricular Fibrillation (VFib) and to delay the administration of epinephrine in these patients as epinephrine can potentiate these shockable rhythms.If, on your first look, the patient is in VTach or VFib, you should defibrillate, give amiodarone, and delay giving epinephrine until the third shock. If on your next rhythm check, you encounter Pulseless Electrical Activity (PEA) or Asystole, then the strategy should be switched, and epinephrine should be given immediately. You may end up switching back and forth between epinephrine and amiodarone depending on the changes in the patient’s rhythm.
