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Pulsatile VT Cardioversion — FRCA Final MCQ

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ModerateAnaesthetic Equipment & SafetyPulsatile VT CardioversionFRCA Final

A 45-year-old man (ASA II) develops ventricular tachycardia with a pulse (HR 185 bpm, BP 95/60) during laparoscopic cholecystectomy under general anaesthesia. He is haemodynamically compromised but not pulseless. According to the Resuscitation Council UK algorithm, what is the correct treatment?

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Correct answer: E — Synchronised DC cardioversion starting at 120-150J

Pulsatile VT with haemodynamic compromise (hypotension, reduced consciousness, chest pain, heart failure) requires synchronised DC cardioversion. Start at 120-150J biphasic (or 200J monophasic). Synchronisation prevents the shock being delivered on the T-wave, which could precipitate VF. If the patient had no pulse, unsynchronised defibrillation (150J biphasic) would be appropriate as per the VF/pulseless VT algorithm. Amiodarone is used for stable VT or after failed cardioversion.

Reference: Resuscitation Council UK – 2021 – Peri-arrest tachycardia algorithm; RCOA – 2023 – ALS in the perioperative setting