For stable tachycardia wide complex VT when torsades de pointes is suspected, what is the initial treatment?

• A. Defibrillation & consider sedation ETOMIDATE 0.15 mg/kg IV/IO
• B. MAGNESIUM SULFATE 2 g IV/IO in 50 mL NS over 10 min
• C. Synchronized Cardioversion
• D. Amiodarone 150 mg in 50 mL NS over 10 min

Answer: (B)

Torsades de pointes is a form of wide-complex tachycardia driven by QT prolongation, and magnesium sulfate is the treatment of choice because it stabilizes the cardiac membrane and suppresses the early afterdepolarizations that trigger torsades. Give 2 g IV/IO in 50 mL normal saline over about 10 minutes even if serum magnesium is normal, since this effect helps resolve the arrhythmia and prevent recurrence. If the rhythm persists or the patient becomes unstable, proceed with synchronized cardioversion, and escalate as needed. Amiodarone is not the first-line choice specifically for torsades, and sedating with etomidate is only for facilitating procedures like cardioversion, not the primary antiarrhythmic therapy.