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Tachycardia-Unstable (CP, ↓BP, SOB, or ALOC)

Perform immediate synchronized cardioversion.
Monomorphic VT and A-fib 100 J, 200 J, 300 J, 360 J.
A-flutter and SVT—may start with 50 J.
Polymorphic VT—unsynchronized with 360 J.
Premedicate with sedative and analgesia whenever possible.

If delays in synchronization occur and clinical situation is critical, go immediately to unsynchronized cardioversion at 360 J.

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