What should be done if no Lidocaine was given prior to ROSC?

In the context of post-resuscitation care, if Lidocaine was not administered prior to return of spontaneous circulation (ROSC), the appropriate action is to give a Lidocaine bolus followed by an infusion. This is based on the understanding that Lidocaine, an antiarrhythmic medication, can be effective in treating certain types of ventricular arrhythmias that may arise after ROSC, particularly in patients who have experienced a cardiac arrest.

When ROSC occurs, there is a heightened risk of arrhythmias due to myocardial irritability and potential ischemia. Administering Lidocaine can help stabilize the heart's rhythm and prevent further complications. Initiating a bolus allows for a rapid increase in plasma levels of the medication, which can help address any immediate rhythm disturbances.

Continuing with observation alone would not actively manage potential arrhythmias. While immediate CPR is crucial during cardiac arrest, it is not a suitable step once ROSC has occurred if there is a need for antiarrhythmic intervention. Replacing Lidocaine with Amiodarone is not appropriate unless specifically indicated, as the question centers on the absence of Lidocaine and presumes that the plan is to use Lidocaine to manage potential complications following ROSC.