A 48-year-old man presents to the Emergency Department by ambulance after patient was found to be unresponsive in his care. According to the paramedics, patient is found to be in the rhythm as below:

ACLS is initiated and after resuscitation with 5 rounds of epinephrine and 5 defibrillations, the patient arrives in the ED. Patient continues to be in the above rhythm. What is the next best treatment? 

A.  Sotalol

B.   Esmolol

C.   Epinephrine

D.  Magnesium Sulfate

E.   Procainamide

B. Esmolol. This patient is in refractory ventricular fibrillation where they have an increase in sympathetic tone which results in increased myocardial oxygen demand and depresses the ventricular fibrillation threshold. Esmolol due to its fast onset and short half-life is an optimal sympatholytic. 

Helmon, Anton. “ BCE Esmolol in Refractory Ventricular Fibrillation.” July 3, 2018. <https://emergencymedicinecases.com/esmolol-refractory-ventricular-fibrillation/.>10/10/19.