Protocol for management of haemodynamically stable ventricular tachycardia

The steps used in the resuscitation procedure are outlined:

• give high flow oxygen
• establish i.v. access
• check serum potassium; if less than 4 mmol/l:
  • give up to 60 mmol potassium chloride at maximum rate of 30 mmol per hour
• if hypokalaemic, assume patient also to be hypomagnesaemic:
  • give 10 mmol magnesium sulphate over 30 minutes (5 mls of 50% solution)
• give either:
  • amiodarone 150 mg in 20 mls 5% solution over 10 minutes; OR
  • lignocaine 50 mg over 2 minutes repeated every 5 minutes up to a maximum of 200mg
    • start a lignocaine infusion at 2 - 4 mg per minute
• if VT persists, obtain expert help; consider:
  • cardioversion (i.e. synchronised DC shocks at monophasic energy levels of 100J:200J:360J or biphasic equivalents)
  • further amiodarone 150 mg in 20 mls 5% dextrose over 10 minutes)