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protocol for management of haemodynamically stable ventricular tachycardia

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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)

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