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Unstable ventricular tachycardia — DipIMC MCQ

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ModerateResuscitationUnstable ventricular tachycardiaDipIMC

A 52-year-old man has a witnessed collapse after chest pain. The monitor shows broad-complex tachycardia at 190 bpm; he is pale, confused and has a systolic blood pressure of 70 mmHg with a carotid pulse. What is the most appropriate management?

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Correct answer: A — Perform synchronised electrical cardioversion with sedation if feasible

Unstable tachycardia with a pulse requires synchronised cardioversion, with sedation where this does not cause harmful delay. Adenosine may be useful in selected regular narrow-complex tachycardias and diagnostically in some stable regular broad-complex rhythms, but not as first-line treatment in shock. Chest compressions are for pulseless patients. The pearl is that electrical therapy is indicated by instability, not by rhythm appearance alone.

Reference: Resuscitation Council UK Adult ALS Guidelines 2025