In the management of Adult Unstable Ventricular Tachycardia, which sedative dose is used before synchronized cardioversion?

• A. Lidocaine: 1 mg/kg IV/IO Push (100 mg max)
• B. Ketamine: 50 mg IV
• C. Etomidate: 10 mg IV/IO
• D. Adenosine: 6 mg IV

Answer: (C)

Sedation is used before synchronized cardioversion in an unstable VT patient to keep the patient still and comfortable during the procedure without causing significant drops in blood pressure or cardiac output. The best choice for this setting is etomidate because it works quickly and has minimal effects on heart rate and blood pressure, offering reliable unconsciousness with little hemodynamic compromise. Lidocaine is an antiarrhythmic, not a sedative, so it doesn’t address the need for patient comfort during shock. Ketamine can raise heart rate and blood pressure through sympathetic stimulation, which is not ideal when the patient is unstable due to a tachyarrhythmia. Adenosine is used for certain supraventricular tachycardias and is not a sedative; it wouldn’t serve the procedural need here. Therefore, a rapid-acting, hemodynamically favorable sedative like etomidate is used, with a typical dose around 10 mg IV/IO in many protocols.