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.