1. Current ACLS guidelines recommend immediate electrical defibrillation with 200 J. If ventricular fibrillation persists, defibrillation should be repeated immediately with 200 to 300 J for the second attempt and increased to 360 J for the third attempt.
2. If the initial three attempts at defibrillation are unsuccessful, CPR should be initiated and, according to ACLS guidelines, further electrical defibrillations done after the administration of various intravenous drugs.
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