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
■ Systolic BP < 90 mmHg 1 Chest pain 1 Heart failure
1 Heart rate > 200 beats min-1
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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