A 40-year-old patient presents with sudden cardiac arrest. Bystander CPR is initiated, and an automated external defibrillator (AED) is applied, which delivers a shock for ventricular fibrillation. After the shock, the patient remains pulseless. What is the next step in management?

A. Administer epinephrine
B. Perform immediate intubation
C. Continue CPR with rhythm and pulse checks
D. Initiate therapeutic hypothermia protocol

During bystander cardiopulmonary resuscitation (CPR), the rescuers typically do not have access to medications like epinephrine to administer to the patient and, without the proper training in advanced cardiac life support (ACLS), nor should they administer these medications. The same applies to intubation -- which can damage, and thus compromise, the airway if performed incorrectly -- and initiation of hypothermia protocols.

After the shock is delivered via the automated external defibrillator (AED), if return of spontaneous circulation (ROSC) is not reached, the patient will still require the rescuers to provide high-quality chest compressions and breaths of oxygen via bag mask, because they are not pumping blood on their own, nor are they breathing on their own.

Therefore, if the patient remains pulseless, the next step in management is to continue CPR with rhythm and pulse checks, option C. Keep the AED pads on the patient, continue cycling through CPR (30 compressions to 2 breaths), and prepare to analyze for a shockable rhythm until ROSC is achieved or emergency services arrive.