For a patient with unstable sustained VT lasting more than 30 seconds, what is the first-line treatment?

For a patient with unstable sustained VT lasting more than 30 seconds, what is the first-line treatment?

• A. Defibrillation
• B. Synchronized cardioversion
• C. Intravenous beta-blocker
• D. Pacemaker implantation

Answer: (B)

When a patient has unstable sustained ventricular tachycardia, the priority is to rapidly restore a stable rhythm and improve perfusion. Synchronized cardioversion accomplishes this by delivering a shock timed to the R wave, terminating the VT while minimizing the risk of provoking lethal rhythms. The patient’s instability means you can’t rely on slower, medical strategies alone; you need an immediate, rhythm-control intervention that preserves circulation. If there were no pulse, the approach would change to defibrillation (an unsynchronized shock) because there’s no need to time the hit to the cardiac cycle when there’s no effective forward flow. Intravenous beta-blockers aren’t appropriate here since they can further depress blood pressure and cardiac output in an unstable patient. Pacemaker implantation isn’t an acute remedy for a ter­rible, chaotic rhythm like VT; it’s used for chronic rhythm management or bradyarrhythmias, not immediate stabilization of VT.

When a patient has unstable sustained ventricular tachycardia, the priority is to rapidly restore a stable rhythm and improve perfusion. Synchronized cardioversion accomplishes this by delivering a shock timed to the R wave, terminating the VT while minimizing the risk of provoking lethal rhythms. The patient’s instability means you can’t rely on slower, medical strategies alone; you need an immediate, rhythm-control intervention that preserves circulation.

If there were no pulse, the approach would change to defibrillation (an unsynchronized shock) because there’s no need to time the hit to the cardiac cycle when there’s no effective forward flow. Intravenous beta-blockers aren’t appropriate here since they can further depress blood pressure and cardiac output in an unstable patient. Pacemaker implantation isn’t an acute remedy for a ter­rible, chaotic rhythm like VT; it’s used for chronic rhythm management or bradyarrhythmias, not immediate stabilization of VT.