Defibrillator Refractory VF
Consider apply 2 defibrillators and delivering double sequential external shocks
Consider esmolol bolus 500 mcg/kg IVP over 30 seconds followed by drip of 50 mcg/kg/min if ROSC obtained 
Consider stellate ganglion nerve block
Consider apply 2 defibrillators and delivering double sequential external shocks
Consider esmolol bolus 500 mcg/kg IVP over 30 seconds followed by drip of 50 mcg/kg/min if ROSC obtained 
Consider stellate ganglion nerve block
Defibrillation
Synchronized cardioversion
Transcutaneous pacing
Transvenous pacing
Double simultaneous external defibrillation
Vagal maneuvers
Awake intubation
Pericardiocentesis