A ventricular tachycardia with a pulse and instability is best managed by?

• A. Vagal maneuvers
• B. Defibrillation (unsynchronized)
• C. Synchronized cardioversion
• D. Adenosine administration

Answer: (C)

When ventricular tachycardia is with a pulse but the patient is unstable, the priority is to rapidly restore a stable rhythm with synchronized cardioversion. The pulse means we’re not in cardiac arrest yet, but the instability signals that the rhythm could deteriorate quickly. Delivering a shock synchronized to the R wave ensures the energy is delivered at a safe moment in the cardiac cycle, reducing the risk of provoking ventricular fibrillation.

Defibrillation without synchronization is reserved for pulseless VT or ventricular fibrillation, where there is no organized rhythm to time to, so shocking unsynchronized in a VT with a pulse could worsen the situation. Adenosine and vagal maneuvers aren’t reliable for terminating VT with instability and won’t effectively treat this rhythm. So synchronized cardioversion is the best choice to quickly convert to a stable rhythm.