If VT persists after initial synchronized cardioversion, what does the protocol recommend?

• A. Repeat synchronized cardioversion or defibrillate and reassess sedation needs
• B. Administer adenosine
• C. Administer magnesium sulfate
• D. Move to intubation

Answer: (A)

When ventricular tachycardia with a pulse doesn’t convert with the first synchronized shock, the plan is to try again with another synchronized cardioversion and reassess sedation needs to help tolerate the repeated shocks. Repeating the synchronized shock is appropriate because VT with a pulse is treated with shock therapy, and sometimes multiple attempts are needed to interrupt the tachycardia while keeping the patient comfortable. If repeated attempts fail and the rhythm remains VT (or deteriorates to pulseless VT), defibrillation (unsynchronized shock) becomes the next step, with resuscitation as indicated. Adenosine isn’t used for VT and magnesium is reserved for torsades de pointes or specific electrolyte issues, not routine VT after failed cardioversion. Intubation isn’t the immediate action here unless airway or respiratory status requires it.