Ventricular tachycardia with palpable pulse

1. A palpable pulse with heart rate >120 bpm with a wide QRS (>0.08 seconds) is present. Initiate cardiac monitoring, administer oxygen and ventilate.

2. If vascular access is available, administer a lidocaine bolus of 1 mg/kg; if successful, begin lidocaine infusion at 20-50 pg/kg/minute.

3. If ventricular tachycardia persists, perform synchronized cardioversion using 0.5 J/kg.

4. If ventricular tachycardia persists, repeat synchronized cardioversion using 1.0 J/kg.

5. If ventricular tachycardia persists, administer a lidocaine bolus of 1.0 mg/kg, and begin lidocaine infusion at 20-50 pg/kg/min.

6. Repeat synchronized cardioversion as indicated.

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