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protocol for management of haemodynamically unstable ventricular tachycardia

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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

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