For unstable tachycardia wide complex VT suspected to be torsades de pointes (polymorphic VT), what is the appropriate action?

For unstable tachycardia wide complex VT suspected to be torsades de pointes (polymorphic VT), what is the appropriate action?

• A. Magnesium sulfate 2 g IV/IO in 50 mL NS over 10 min
• B. Defibrillate & consider sedation ETOMIDATE 0.15 mg/kg IV/IO
• C. Repeat defibrillation; assess need for repeat sedation
• D. Synchronized Cardioversion

Answer: (B)

When a wide-complex tachycardia is unstable and torsades de pointes is suspected, the immediate goal is to rapidly terminate the dangerous rhythm to restore perfusion. Delivering a defibrillating shock provides the fastest way to stop the chaotic electrical activity and reset the heart, which is crucial in a hemodynamically compromised patient. Sedation with etomidate can be considered to facilitate the procedure and ensure the patient tolerates it (or to enable a controlled cardioversion if needed), with the dosing typically around 0.15 mg/kg IV/IO. After the rhythm is acutely interrupted, you would address contributing factors and consider magnesium as part of the longer-term management of torsades.

When a wide-complex tachycardia is unstable and torsades de pointes is suspected, the immediate goal is to rapidly terminate the dangerous rhythm to restore perfusion. Delivering a defibrillating shock provides the fastest way to stop the chaotic electrical activity and reset the heart, which is crucial in a hemodynamically compromised patient. Sedation with etomidate can be considered to facilitate the procedure and ensure the patient tolerates it (or to enable a controlled cardioversion if needed), with the dosing typically around 0.15 mg/kg IV/IO. After the rhythm is acutely interrupted, you would address contributing factors and consider magnesium as part of the longer-term management of torsades.