VT – When to Shock, When to Drug?

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Management of Ventricular Tachycardia

Hemodynamically Unstable VT
Immediate electrical cardioversion
Biphasic defibrillator: 100–200 J
Monophasic defibrillator: 200–360 J

Lidocaine Therapy
Initial bolus: 1.0–1.5 mg/kg IV
Repeat bolus: 0.5–0.75 mg/kg (max 3 mg/kg total)
Maintenance infusion: 1–4 mg/min

Procainamide Therapy
Loading dose: 10 mg/kg IV over 20 min
Infusion rate: 30–50 mg/min
Max dose: 18 mg/kg
Monitor: Hypotension, QTc prolongation

Amiodarone Therapy
Bolus dose: 150 mg IV over 10 min
Initial infusion: 1 mg/min for 6 hrs
Maintenance infusion: 0.5 mg/min for 18 hrs
Monitor: Bradycardia, hypotension, liver function

Summary & Key Points
Unstable VT → Immediate cardioversion
Drug options:
Lidocaine (bolus + infusion)
Procainamide (slow infusion, monitor QT)
Amiodarone (prolonged infusion, multi-organ monitoring)
Continuous hemodynamic assessment