Pediatric Stable VT: If Amiodarone is unavailable, which drug and dose is recommended?

• A. Amiodarone: 5 mg/kg IV/IO
• B. Lidocaine: 1 mg/kg IV/IO Push (100 mg max)
• C. Epinephrine: 0.01 mg/kg
• D. Magnesium sulfate: 40 mg/kg

Answer: (B)

When a child with stable ventricular tachycardia doesn’t have amiodarone available, lidocaine given as a single IV/IO bolus at 1 mg/kg (with a maximum of 100 mg) is the recommended next step. Lidocaine acts quickly to suppress ventricular arrhythmias, making it a practical and effective alternative in this situation. If the VT recurs, additional dosing or a short course of infusion can be used per protocol.

The other options aren’t the best fit here: epinephrine is a vasopressor used during CPR, not to terminate stable VT; magnesium sulfate is mainly for torsades de pointes or specific electrolyte issues; and amiodarone would be preferred but is not available in this scenario.