Treatment for Compromised Patients

In any patient compromised by their monomorphic VT the treatment of choice is DC cardioversion. Signs of instability according to the Resuscitation Council (UK) include reduced conscious level, chest pain, systolic blood pressure of <90 mmHg or heart failure.

Start with a synchronised DC cardioversion at 200 J (monophasic) or 120-150 J (biphasic). If unsuccessful repeat the cardioversion up to a maximum of three attempts before giving amiodarone. Changing the paddle position may be helpful in resistant cases.

The flowchart is adapted from the UK Resuscitation Council Guidelines and illustrates the protocol for treating a BCT [1].