Assume ventricular tachycardia until proven otherwise
Only for regular<unk> s, if irregular consider a-fib with block
Only for treatment decision if patient is stable
Absence of an RS<unk>  in all precordial leads?
If yes then VT
If no then continue
RS interval >100ms in any precordial lead? (onset of R wave to deepest part of S wave)
If yes then VT
If no then continue
AV dissociation?
If yes then VT
If no then continue
Morphology criteria for v-tach present in both V1-2 and V6?
If yes then VT
If no then possibly SVT with aberrant conduction
If yes then VT
If no then continue
If yes then VT
If no then continue
If yes then VT
If no then continue
If yes then VT
If no then possibly SVT with aberrant conduction
In lead aVR:
Presence of an initial R wave?
If yes then VT
If no then continue
Presence of an initial r or q wave >40ms
If yes then VT
If no then continue
Presence of a notch on descending limb of a negative onset, predominantly negative QRS?
If yes then VT
If no then continue
Ventricular activation-velocity ratio (Vi/Vt) ≤1?
If yes then VT
If no then SVT
If yes then VT
If no then continue
If yes then VT
If no then continue
If yes then VT
If no then continue
If yes then VT
If no then SVT
Combination of the most specific aspects of the above two algorithms
Acronym: CARMA → Concordance → aVR →Regular → Morphology →AV dissociation
Presence of an initial R wave in aVR? 
If yes then VT
If no then continue
Is there concordance (monophasic with same polarity) in all of the precordial leads? 
If yes then VT   Example of concordance in precordial leads  Example of disconcordance in precordial leads
If no then continue
Is there evidence of AV dissociation/Capture beats?   Example of capture beat
If yes then VT
If no then continue
Is the QRS morphology in V1 and V6 consistent with either LBBB or RBBB? 
If no then VT
If yes then SVT with aberrancy
If yes then VT
If no then continue
If yes then VT   Example of concordance in precordial leads  Example of disconcordance in precordial leads
If no then continue
If yes then VT
If no then continue
If no then VT
If yes then SVT with aberrancy
In lead II, if the TIME in (ms) it takes the R wave to go from the isoelectric line to its peak voltage is greater than 50ms, it is VT
Positive Likelihood ratio of 34.8
Josephson's sign --- notching or slurring near the nadir of the S-wave is characteristic of V. Tach Josephson's Sign Vtach
Rsr' sign --- A taller left R wave in v1-v2 is very specific for VT, as opposed in a RBBB where the second/right R-wave (R') is taller
"Northwest" axis deviation -- Negative QRS<unk>  in I, AVF and Positive QRS in AVR
Rhythm diagnosis in regular wide complex tachycardia
Assume any wide-complex tachycardia is ventricular tachycardia until proven otherwise 
ECG Stampede
Regular
STEMI mimics
Monomorphic ventricular tachycardia
ECGs by Diagnosis
PSVT with aberrant conduction: