رجل عمره ٦٦ سنة بعد احتشاء قديم، صار عنده خفقان ودوخة. الشاشة تظهر تسارعاً بطينياً بسرعة ١٦٠ وله نبض. الضغط ٧٨/٤٠، والتشبع ٩١٪، وهو مشوش ويتعرق. ما العلاج الأنسب؟

A 66-year-old man with a previous MI develops palpitations and dizziness. The monitor shows ventricular tachycardia at 160 with a pulse. BP 78/40, SpO2 91%; he is confused and sweaty. What is the most appropriate treatment?

1. Rhythm monitoring and oral amiodarone
2. Synchronised cardioversion with sedation if possible
3. Immediate unsynchronised defibrillation at the highest energy
4. A rapid adenosine push, then reassess

Answer: B) Synchronised cardioversion with sedation if possible. Pulsed VT with instability (hypotension, confusion) needs synchronised cardioversion. Unsynchronised shocks are for pulseless VT and VF. Drugs are for the stable client.