Pulseless: see Adult pulseless arrest
Unstable: Hypotension, altered mental status, shock, ischemic chest discomfort, acute heart failure
Synchronized cardioversion 100-200J
Stable:
Medications
Procainamide (first-line drug of choice)
20-50mg/min until arrhythmia suppressed (max 17mg/kg or 1 gram); then, maintenance infusion of 1-4mg/min x 6hr
Alternative administration: 100 mg q5min at max rate of 25-50 mg/min
Stop if QRS duration increases >50% or hypotension
Avoid if prolonged QT or CHF
Favored over Amiodarone in PROCAMIO trial; termination of tachycardia in 67% of procainamide group vs 38% of amiodarone group, adverse cardiac events 9% vs 41%, respectively 
Amiodarone (agent of choice in setting of AMI or LV dysfunction)
150 mg over 10min (15 mg/min), followed by 1 mg/min drip over 6hrs (360 mg total)
Then 0.5 mg/min drip over next 18 hrs (540 mg total)
Oral dosage after IV infusion is 400 -800 mg PO daily
Consider adenosine
Consider for diagnosis and treatment, if rhythm is regular and monomorphic (see rhythm diagnosis in regular wide complex tachycardia)
6 mg IV as a rapid IV push followed by a 20 mL saline flush; repeat if required as 12 mg IV push
Synchronized Cardioversion (100J)
Synchronized cardioversion 100-200J
Procainamide (first-line drug of choice)
20-50mg/min until arrhythmia suppressed (max 17mg/kg or 1 gram); then, maintenance infusion of 1-4mg/min x 6hr
Alternative administration: 100 mg q5min at max rate of 25-50 mg/min
Stop if QRS duration increases >50% or hypotension
Avoid if prolonged QT or CHF
Favored over Amiodarone in PROCAMIO trial; termination of tachycardia in 67% of procainamide group vs 38% of amiodarone group, adverse cardiac events 9% vs 41%, respectively 
Amiodarone (agent of choice in setting of AMI or LV dysfunction)
150 mg over 10min (15 mg/min), followed by 1 mg/min drip over 6hrs (360 mg total)
Then 0.5 mg/min drip over next 18 hrs (540 mg total)
Oral dosage after IV infusion is 400 -800 mg PO daily
Consider adenosine
Consider for diagnosis and treatment, if rhythm is regular and monomorphic (see rhythm diagnosis in regular wide complex tachycardia)
6 mg IV as a rapid IV push followed by a 20 mL saline flush; repeat if required as 12 mg IV push
20-50mg/min until arrhythmia suppressed (max 17mg/kg or 1 gram); then, maintenance infusion of 1-4mg/min x 6hr
Alternative administration: 100 mg q5min at max rate of 25-50 mg/min
Stop if QRS duration increases >50% or hypotension
Avoid if prolonged QT or CHF
Favored over Amiodarone in PROCAMIO trial; termination of tachycardia in 67% of procainamide group vs 38% of amiodarone group, adverse cardiac events 9% vs 41%, respectively 
Alternative administration: 100 mg q5min at max rate of 25-50 mg/min
150 mg over 10min (15 mg/min), followed by 1 mg/min drip over 6hrs (360 mg total)
Then 0.5 mg/min drip over next 18 hrs (540 mg total)
Oral dosage after IV infusion is 400 -800 mg PO daily
Consider for diagnosis and treatment, if rhythm is regular and monomorphic (see rhythm diagnosis in regular wide complex tachycardia)
6 mg IV as a rapid IV push followed by a 20 mL saline flush; repeat if required as 12 mg IV push
Unstable: Hypotension, altered mental status, shock, ischemic chest discomfort, acute heart failure
Unsynchronized cardioversion (defibrillation) 200J
Stable:
A fib with preexcitation
1st line - Electric Cardioversion
2nd line - Procainamide, amiodarone, or sotalol
A fib with aberrancy
Polymorphic V-Tach / Torsades De Pointes
Give IV MgSO4
Emergent defibrillation (NOT synchronized)
Correct electrolyte abnormalities (esp hypoK, hypoMg)
Stop prolonged QT meds
Unsynchronized cardioversion (defibrillation) 200J
1st line - Electric Cardioversion
2nd line - Procainamide, amiodarone, or sotalol
Give IV MgSO4
Emergent defibrillation (NOT synchronized)
Correct electrolyte abnormalities (esp hypoK, hypoMg)
Stop prolonged QT meds
ACLS: Tachycardia
Regular
PALS: Tachycardia
AV Node Independent
ACLS: Bradycardia
Sinus tachycardia
PALS: Bradycardia
Atrial tachycardia 