• Unstable signs and symptoms may include chest pain, shortness of breath, decreased level of consciousness, low blood pressure, shock, pulmonary congestion, congestive heart failure, acute myocardial infarction.
• If ventricular rate is >150 BPM, prepare for immediate cardioversion. May give brief trial of medications based on specific arrhythmias. Immediate cardioversion is generally not needed for rates <150 BPM.
• Have available at bedside: oxygen saturation, suction device, IV line, intubation equipment
• Premedicate whenever possible
• Effective regimens have included a sedative (e.g., diazepam, midazolam, barbiturates, etomidate, ketamine, and methohexital) with or without an analgesic agent (e.g., fentanyl, morphine, and meperidine).
• Synchronized cardioversion for VT, PSVT, Atrial Fib, Atrial flutter at 100 J, 200 J, 300 J, 360 J. Note Atrial flutter often responds to lower energy levels (start with 50 J)
• Polymorphic VT (irregular form and rate) often requires more energy. Start with 200 J..

To: ACLS Intravenous Medicated Infusions