Option C is the correct answer.
The current AHA guidelines for CPR and Emergency Cardiovascular Care recommend using 120–200J for the initial biphasic shock, and also recommend that “second and subsequent energy levels should be at least equivalent and higher energy levels may be considered.
Biphasic shock can reach as high an 360J in subsequent shock.
200j-see guideline 11.5 of the australian guidelines, and page 45 of the uk guidelines.for rectilinear biphasic waveforms the energy should be greater than 120j, and for truncated exponenetial waveforms it should be greater than 150j.theefore, it isrecommended that the initial shock should be at least 150j, with 200j being within the effective range of first and subsequent biphasic shock energy levels.every biphasic manual defibrillator available can deliver 200j.if there is clinical data to support the use of a different energy level for a specific device, then this may be used. the phillips heartstart xl has been shown to be effective at 150j.there is no evidence to suggest a clear benefit for either a fixed or escalating energy level.