Wide-QRS Tachycardia (VT) — Management Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

🎓 Want to practice? Do a case challenge with this pathway → (get a case, choose management step by step, scored).

Full pathway

1. [Decision] Stable or unstable
   Wide-QRS tachycardia — stable or unstable? (Wide-QRS (≥0.12 s) tachycardia is treated as VT by default (treat as VT when in doubt). Unstable signs: hypotension/shock, altered consciousness, ischemic chest pain, acute heart failure. Check the pulse first: pulseless → manage as cardiac arrest (CPR + defibrillation).)
   • Unstable (with pulse) → Unstable → synchronized cardioversion
   • Stable → Stable → antiarrhythmic
2. [End] Unstable → synchronized cardioversion
   Immediate synchronized cardioversion (sedate the conscious patient first, midazolam ± fentanyl). Wide and regular: start ~100 J; wide and irregular (polymorphic VT / suspected VF): defibrillate unsynchronized at 200 J as for VF. Pulseless → immediate CPR + defibrillation (cardiac arrest pathway). After conversion, find and correct triggers (electrolytes, ischemia).
3. [End] Stable → antiarrhythmic
   12-lead ECG, expert consultation, IV access. Single antiarrhythmic — amiodarone 150 mg IV over 10 min (may repeat), or procainamide 20–50 mg/min (until conversion / hypotension / QRS widening >50% / 17 mg/kg); avoid procainamide/sotalol with prolonged QT. Only for regular monomorphic, adenosine 6 mg rapid IV push may be tried (also diagnostic). Avoid beta-blockers/CCB/digoxin (can precipitate collapse when the mechanism is unclear). Drug-refractory → elective synchronized cardioversion.

Source guidelines & references

• AHA ACLS adult tachycardia (with pulse) algorithm; 2020 CPR & ECC guidelines

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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