See Adult pulseless arrest and Pediatric pulseless arrest
Unsynchronized cardioversion (defibrillation) 200J (or 2J/kg for pediatrics)
Correct any electrolyte abnormalities
Correct any electrolyte abnormalities
Torsades:
Magnesium sulfate (for Torsades):
1-2gm IV, repeat in 5-15min; then 1-2gm/hr (3-10mg/min) drip
Peds: 25-50mg/kg (max 2g) IV
Sotalol (100mg IV over 5 minutes)
Isoproterenol, 2-8 mcg/min
Overdrive Pacing to goal HR 90-120
Note that this is only effective for preventing recurrence of TdP - it will not convert TdP to sinus rhythm
Avoid procainamide, amiodarone (may further prolong QT)
Non-Torsades (baseline QT interval not prolonged)
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)
Peds: 5mg/kg (max 300mg), may repeat twice
Procainamide
100 mg q5min until termination of arrhythmia, then start 2-6 mg/min (or 1-2 mg/min for renal/cardiac failure)
Max dose 17mg/kg OR widening of QRS >50%
Lidocaine, 1-1.5mg/kg IV q5min, repeat PRN up to 300mg/hr
Beta-blockers (e.g. metoprolol 5mg IV q5m x 3) if blood pressure tolerates
Magnesium sulfate (for Torsades):
1-2gm IV, repeat in 5-15min; then 1-2gm/hr (3-10mg/min) drip
Peds: 25-50mg/kg (max 2g) IV
Sotalol (100mg IV over 5 minutes)
Isoproterenol, 2-8 mcg/min
Overdrive Pacing to goal HR 90-120
Note that this is only effective for preventing recurrence of TdP - it will not convert TdP to sinus rhythm
Avoid procainamide, amiodarone (may further prolong QT)
1-2gm IV, repeat in 5-15min; then 1-2gm/hr (3-10mg/min) drip
Peds: 25-50mg/kg (max 2g) IV
Note that this is only effective for preventing recurrence of TdP - it will not convert TdP to sinus rhythm
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)
Peds: 5mg/kg (max 300mg), may repeat twice
Procainamide
100 mg q5min until termination of arrhythmia, then start 2-6 mg/min (or 1-2 mg/min for renal/cardiac failure)
Max dose 17mg/kg OR widening of QRS >50%
Lidocaine, 1-1.5mg/kg IV q5min, repeat PRN up to 300mg/hr
Beta-blockers (e.g. metoprolol 5mg IV q5m x 3) if blood pressure tolerates
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)
Peds: 5mg/kg (max 300mg), may repeat twice
100 mg q5min until termination of arrhythmia, then start 2-6 mg/min (or 1-2 mg/min for renal/cardiac failure)
Max dose 17mg/kg OR widening of QRS >50%
≥3 episodes within 24 hours considered electrical storm
May require alternate treatment (i.e. β-blockers, sedation, ablation)
Polymorphic ventricular tachycardia
Assume any wide-complex tachycardia is ventricular tachycardia until proven otherwise 
Wandering atrial pacemaker
Regular
Wide-complex tachycardia
Monomorphic ventricular tachycardia
Accelerated idioventricular rhythm
PSVT with aberrant conduction: