In the Stable Tachycardia Wide Complex Tachycardia algorithm, which Adenosine dosing is listed first?

• A. Adenosine 6 mg rapid IVP/IO
• B. Amiodarone 150 mg
• C. Adenosine 12 mg rapid IVP/IO
• D. Vagal maneuvers

Answer: (D)

In this context, the key idea is that wide-complex tachycardia is managed with caution about rhythm identification and safety, and non-drug maneuvers are used first before any adenosine dosing. Adenosine is primarily for narrow-complex SVT and can be risky if the rhythm is actually VT or VT with aberrancy. Because the first step in the stable wide-complex tachycardia algorithm is to attempt a safe, quick, nonpharmacologic intervention to help differentiate rhythms and potentially slow conduction through the AV node, vagal maneuvers are listed first. If vagal maneuvers don’t yield a result and the rhythm remains wide complex, the next steps would involve appropriate pharmacologic therapies (such as amiodarone) or other protocol-specific actions, but adenosine dosing isn’t the initial move in a stable wide-complex tachycardia. The other options represent doses or drugs that are not the first-line initial step in this scenario, which is why the algorithm prioritizes vagal maneuvers up front.