# Wide-complex tachycardia with a pulse

Separate stable transport from unstable synchronized cardioversion and medication steps.

Population: Adult / adolescent. Scope: ALS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: See the linked OCEMS source for revision and implementation dates..
Canonical page: https://www.ocmedic.com/guides/wide-complex-tachycardia/
Official source: [SO-C-040 — Wide QRS Complex Tachycardia with a Pulse - Adult/Adolescent](https://www.ochealthinfo.com/sites/healthcare/files/2025-10/SO-C-40%20VT%20with%20Pulse%20%2810-2025%29.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Key cautions & base contact

- Use synchronized cardioversion for the pulsed pathway and confirm synchronization before each shock.
- Do not substitute the 300 mg arrest amiodarone dose for this 150 mg slow-infusion pathway.

## Source documents

- [SO-C-040 — Wide QRS Complex Tachycardia with a Pulse - Adult/Adolescent](https://www.ochealthinfo.com/sites/healthcare/files/2025-10/SO-C-40%20VT%20with%20Pulse%20%2810-2025%29.pdf)

## Assess and document

- Confirm a pulse, monitor rhythm, and obtain a rhythm strip or 12-lead. Assess BP, mental status, chest symptoms, and perfusion.
- If an implanted defibrillator fires at least twice in 15 minutes, contact base for possible CVRC destination. For SpO₂ below 95%, provide oxygen as directed by the source.

## Stable patient

- The stable branch describes systolic BP above 90, appropriate mental status, and minimal chest discomfort. Monitor serial vital signs and provide ALS escort to the nearest ERC.
- The treatment guideline favors transport without cardioversion or pharmacologic treatment for stable wide-complex tachycardia. Continue looking for deterioration.

## Unstable patient

- Systolic BP at or below 90, altered consciousness, chest pain, or poor perfusion activates the unstable branch. Synchronized cardioversion starts at 100 J biphasic or the manufacturer-recommended setting; do not delay for IV access if deteriorating.
- If unsuccessful, give amiodarone 150 mg slow IV/IO OR lidocaine 1 mg/kg IV/IO. After 2–3 minutes of infusion, persistent unstable tachycardia leads to synchronized full-output/manufacturer-setting cardioversion.
- If persistent, repeat amiodarone 150 mg slow IV/IO OR lidocaine 0.5 mg/kg IV/IO, followed after 2–3 minutes by the next synchronized cardioversion step if needed.

## Reassess and transport

- Reassess pulse, rhythm, BP, consciousness, and perfusion after every intervention. Amiodarone can cause hypotension, especially if administered too rapidly.
- Provide ALS escort to the nearest ERC or contact base as needed. If the pulse is lost, switch immediately to the arrest pathway.