Ventricular Tachycardia with a Pulse Algorithm

Identify and treat underlying cause
• Maintain patent airway; assist breathing as necessary
• Oxygen (if hypoxemic)
• Cardiac monitor to identify rhythm; monitor blood pressure and oximetry
• IV access
• 12-lead ECG, if available

If witnessed, Thump

Check BP

Amiodarone 150 mg on 100cc over 10 min

Check BP

Amiodarone drip at 1 mg/minute

Antiarrhythmic Infusions for Stable Wide-QRS Tachycardia
Procainamide IV dose: 20-50 mg/min until arrhythmia suppressed, hypotension ensues,
QRS duration increases >50%, or maximum dose 17 mg/kg given.
Maintenance infusion: 1-4 mg/min. Avoid if prolonged QT or CHF.

Amiodarone IV dose: First dose: 150 mg over 10 minutes. Repeat as needed if VT recurs.
Follow by maintenance infusion of 1 mg/min for first 6 hours.

Sotalol IV dose:
100 mg (1.5 mg/kg) over 5 minutes. Avoid if prolonged QT.


Check BP

Expert Consultation

Note: Synchronized cardioversion/sedation anytime if Persistent tachyarrhythmia causing:
• Hypotension?
• Acutely altered mental status?
• Signs of shock?
• Ischemic chest discomfort?
• Acute heart failure?  


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