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Answer 6
  1. Administer IV amiodarone and initiate an amiodarone drip. The patient has stable VT. The term “stable” refers only to the notion that the patient has a palpable pulse and a BP that allows for peripheral organ perfusion. The rhythm has lasted for more than 30 seconds, which classifies it as sustained VT, an inherently unstable rhythm that can degenerate into VF. Hence, continued monitoring would not be appropriate. Defibrillation would be appropriate for unstable VT or VF, but is not yet necessary in this setting. Adenosine is only effective for certain idiopathic VTs and is usually ineffective for those associated with structural heart disease, as in this case. The appropriate management is either synchronized electrical cardioversion, which is not optimal in a conscious patient, or initiation of IV antiarrhythmic therapy (eg, procainamide, amiodarone, lidocaine).4

     Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines for the management of patients with ST- elevation myocardial infarction—executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines on the Management of Patients With Acute Myocardial Infarction) [published erratum appears in J Am Coll Cardiol 2005; 45:1376]. J Am Coll Cardiol 2004;44:671-719.

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