protocol for management of haemodynamically unstable ventricular tachycardia
Last reviewed 01/2018
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