After administering one shock to a 46 year old male in cardiac arrest, you feel a strong carotid pulse during a pulse check after two minutes. What should your next step be?

After successfully administering a shock to a patient in cardiac arrest and subsequently detecting a strong carotid pulse, the next logical step is to assess for breathing and manage the airway if necessary. This is because the restoration of a pulse does not guarantee that the patient is breathing adequately or at all.

In this scenario, it is critical to ensure that the airway is clear and that the patient can breathe effectively. If the patient is not breathing adequately, interventions such as ventilation may be required to support their respiratory needs. Managing the airway is a fundamental aspect of post-cardiac arrest care and ensures that the patient receives adequate oxygenation, which is vital for recovery.

Monitoring vital signs continuously and beginning chest compressions might seem important, but they are secondary actions that follow an assessment of the patient's breathing status. If the patient is found to be breathing adequately after assessment, then efforts can shift towards ongoing monitoring rather than immediate chest compressions. Calling for additional emergency services could also be considered, but it would not be the immediate priority following the identification of a strong pulse. Hence, assessing breathing and managing the airway encapsulates the critical first step in stabilizing the patient post-shock.