* ABCs
* Secure Airway
* Administer Oxygen
* Start IV
* Cardiac Monitor , Pulse Oximeter

* Assess Vital Signs
* Review History
* Physical Examination
*  Order 12 leads
* Portable Chest X - Ray

*Chest Pain
*Shortness of Breath
*Decreased Level of
  Consciousness
*Hypotension   *Shock
*Congestive Heart Failure
*Acute Myocardial Infarction
*Ventricular Rate > 150/min

Repeat every 5-10  min

Max. dose of 3mg/kg

Over 1-3 s

After 1-2  min

May Repeat Once in 1-2 min

Max. total dose of 17mg/kg

Max.dose of 30mg/kg/24 H

Sedation *

PSVT / Atrial Flutter - may start with 50 J

Unstable condition must be related to the Tachycardia. 
If Ventricular rate is < 150/min , May give a brief trial of medication based on arrhythmia.

If the Wide Complex Tachycardia is known with certainty to be PSVT and BP is
normal / elevated , sequence can include Verapamil.

Treat Polymorphic VT - Like VF

Magnesium is Class IIa in Torsades De Points and Hypomagnesemia

Premedicate - Effective regiments have included a sedative (eg, Diazepam , Midazolam
Barbiturates , Etomidate , Ketamin , Methohexital) with or without analgestic agent
(eg , Fentanyl , Morphine , Meperidine). Many experts recommend anasthesia.

Paramedic Neomi Zvi - Feb 2000

AHA ; ACLS ; 1994 ; 1-32  -  1-33