Follow current ACLS guidelines if pulseless
See Adult Pulseless Arrest
Analgesia / sedation for all patients
ACC recommends repletion of K to 4.5 in all cases 
See Adult Pulseless Arrest
Amiodarone 1st line antiarrhythmic (preferred over lidocaine) for most cases
Efficacy of lidocaine highest if actively ischemic
Beta blockade: Minimize epinephrine use as much as possible
Consider sympathetic blockade as first line over ACLS antiarrhythmics
Especially in patients that are high risk CAD
67% vs. 5% survival in 49 patient study, respectively for esmolol/propranolol vs. ACLS antiarrhythmic
Patients who survived initial ES event did well over 1 yr follow up
Metoprolol 2.5-5mg IV q2-5 min to max of 15mg
Propranolol 0.15mg/kg IV over 10 minutes followed by 3-5mg q6h; may be effective even if metoprolol fails
More efficacious than metoprolol, terminated VT at 3 hours vs. 18 hours with metoprolol 
Esmolol 300-500 mcg/kg load over 1 minutes follwed by infusion at 25-50 mcg/kg/min initial dose
Efficacy of lidocaine highest if actively ischemic
Consider sympathetic blockade as first line over ACLS antiarrhythmics
Especially in patients that are high risk CAD
67% vs. 5% survival in 49 patient study, respectively for esmolol/propranolol vs. ACLS antiarrhythmic
Patients who survived initial ES event did well over 1 yr follow up
Metoprolol 2.5-5mg IV q2-5 min to max of 15mg
Propranolol 0.15mg/kg IV over 10 minutes followed by 3-5mg q6h; may be effective even if metoprolol fails
More efficacious than metoprolol, terminated VT at 3 hours vs. 18 hours with metoprolol 
Esmolol 300-500 mcg/kg load over 1 minutes follwed by infusion at 25-50 mcg/kg/min initial dose
Especially in patients that are high risk CAD
67% vs. 5% survival in 49 patient study, respectively for esmolol/propranolol vs. ACLS antiarrhythmic
Patients who survived initial ES event did well over 1 yr follow up
More efficacious than metoprolol, terminated VT at 3 hours vs. 18 hours with metoprolol 
Exceptions to above are:
Torsades with known long QT
Magnesium sulfate 1-2 grams IV over 1-2 minutes
Potassium repletion
If bradycardic between episodes, pace at 90-120 or start Isoproterenol 2 mcg/min and titrate to HR 90-100
Consider bolus dose 0.02-0.06mg isoproterenol, then infusion
Brugada syndrome
Isoproterenol infusion is 1st line
Quinidine may be of benefit
Due to its Ito channel blockade
Sodium channel blockade may be harmful, however (avoid other Class I antiarrhythmics)
Consider isoproterenol in<unk>  in the following situations:
Recalcitrant idiopathic ventricular fibrillation, not associated with structural heart,<unk> , coronary heart disease
Benign early repolarization with J waves
Idiopathic ventricular fibrillation with complete right bundle branch block
Consider isoproterenol carefully as it has been used to induce ventricular tachycardia by EPs
Torsades with known long QT
Magnesium sulfate 1-2 grams IV over 1-2 minutes
Potassium repletion
If bradycardic between episodes, pace at 90-120 or start Isoproterenol 2 mcg/min and titrate to HR 90-100
Consider bolus dose 0.02-0.06mg isoproterenol, then infusion
Brugada syndrome
Isoproterenol infusion is 1st line
Quinidine may be of benefit
Due to its Ito channel blockade
Sodium channel blockade may be harmful, however (avoid other Class I antiarrhythmics)
Magnesium sulfate 1-2 grams IV over 1-2 minutes
Potassium repletion
If bradycardic between episodes, pace at 90-120 or start Isoproterenol 2 mcg/min and titrate to HR 90-100
Consider bolus dose 0.02-0.06mg isoproterenol, then infusion
Isoproterenol infusion is 1st line
Quinidine may be of benefit
Due to its Ito channel blockade
Sodium channel blockade may be harmful, however (avoid other Class I antiarrhythmics)
Due to its Ito channel blockade
Sodium channel blockade may be harmful, however (avoid other Class I antiarrhythmics)
Recalcitrant idiopathic ventricular fibrillation, not associated with structural heart,<unk> , coronary heart disease
Benign early repolarization with J waves
Idiopathic ventricular fibrillation with complete right bundle branch block
Consider isoproterenol carefully as it has been used to induce ventricular tachycardia by EPs
Emergent revascularization if ischemic
Ablation
Left sympathetic ganglionic blockade
Deep sedation / general anesthesia
IABP / ECMO
Palliative care as this could represent impending terminal failure
Electrical storm
Assume any wide-complex tachycardia is ventricular tachycardia until proven otherwise 
Heat stroke
Regular
Undifferentiated shock
Monomorphic ventricular tachycardia
Undifferentiated shock 
PSVT with aberrant conduction: