Protocol for management of haemodynamically unstable ventricular tachycardia

The steps used in the resuscitation procedure are outlined:

• provide high flow oxygen
• establish i.v. access
• consider sedation or ideally, intubation with general anaesthesia
• perform cardioversion i.e. synchronised DC shocks
  • for a monophasic defibrillator, start at 100 J
  • if VT persists, increase to 200 J
  • if VT persists, increase to 360J
  • (if using a biphasic defibrillator, use the equivalent biphasic energy levels)
• check serum potassium and correct 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)
• if VT persists, obtain expert help; but consider:
  • amiodarone 150 mg in 20 mls 5% dextrose over 10 minutes
  • further cardioversion
  • other anti-arrhythmics
  • overdrive pacing