A conscious adult with regular monomorphic ventricular tachycardia presents after oxygen and IV access; what action is appropriate next?

A conscious adult with regular monomorphic ventricular tachycardia presents after oxygen and IV access; what action is appropriate next?

• A. Verapamil
• B. Adenosine
• C. Cardioversion
• D. Magnesium

Answer: (B)

In a conscious patient with a regular monomorphic VT, treated as VT with a pulse, the next step is to give an IV antiarrhythmic such as amiodarone. This targets the underlying reentrant tachycardia and helps restore a normal rhythm. Adenosine is not appropriate here because it targets AV-node–dependent tachycardias (SVT with aberrancy) and does not terminate VT; it can also worsen hemodynamics in VT. Verapamil is contraindicated in VT due to potential hypotension and failure to address the arrhythmia, and magnesium is reserved for torsades de pointes rather than typical VT. If the patient showed signs of instability (hypotension, altered mental status, chest pain with poor perfusion), synchronized cardioversion would be the immediate action.

In a conscious patient with a regular monomorphic VT, treated as VT with a pulse, the next step is to give an IV antiarrhythmic such as amiodarone. This targets the underlying reentrant tachycardia and helps restore a normal rhythm. Adenosine is not appropriate here because it targets AV-node–dependent tachycardias (SVT with aberrancy) and does not terminate VT; it can also worsen hemodynamics in VT. Verapamil is contraindicated in VT due to potential hypotension and failure to address the arrhythmia, and magnesium is reserved for torsades de pointes rather than typical VT. If the patient showed signs of instability (hypotension, altered mental status, chest pain with poor perfusion), synchronized cardioversion would be the immediate action.