For unstable pediatric patients with wide complex tachycardia presenting as monomorphic VT, what is the initial management?

• A. Synchronized CardioVersion 0.5-1 J/kg; may use 2 J/kg
• B. Amiodarone 5 mg/kg in 50 mL NS over 20 min
• C. Defibrillate 2 J/kg increasing to 4 J/kg; sedation
• D. Etomidate 0.15 mg/kg IV/IO

Answer: (A)

When a pediatric patient is unstable with wide complex, monomorphic VT and a pulse, the priority is to rapidly terminate the tachyarrhythmia while preserving perfusion. Synchronized cardioversion achieves this by delivering a shock timed to the QRS complex, reducing the chance of triggering worse rhythm while the heart is still beating. Start with an energy of 0.5 to 1 J/kg, and if needed, increase to 2 J/kg. Defibrillation is reserved for pulseless VT orVF, not when a pulse is present. Amiodarone or other meds come into play if the rhythm persists after stabilization, but they are not the initial move in this unstable, pulsed VT scenario.