Adenosine 6 mg by rapid bolus injection; if unsuccessful, follow, if necessary, with up to 3 doses each of 12 mg every 1-min* Caution with adenosine in known Wolff-Parkinson-White syndrome

■ Seek expert help

Adverse signs?

■ Systolic BP < 90 mmHg 1 Chest pain 1 Heart failure

1 Heart rate > 200 beats min-1

Choose from:

Synchronised DC shock t 100 J :200 J : 360 J or equivalent biphasic energy

If necessary, amiodarone 150 mg i.v. over 10 min, then 300 mg over 1 h and repeat shock

■ Esmolol: 40 mg over 1 min + infusion 4 mg min-1

(i.v. injection can be repeated and infusion increased incrementally to 12 mg min-1) OR

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