Unstable VT with a pulse is treated with?

• A. Synchronized cardioversion
• B. Pacemaker insertion
• C. Defibrillation
• D. Immediate CPR without rhythm correction

Answer: (A)

When a patient has unstable ventricular tachycardia but still has a pulse, the goal is to quickly restore a stable rhythm while preserving perfusion. The appropriate maneuver is synchronized cardioversion: deliver a timed, low-energy shock that is coordinated with the QRS complex so the energy is delivered at the moment that minimizes the risk of triggering ventricular fibrillation. This corrects the tachyarrhythmia and reestablishes a normal rhythm more effectively than a rapid defibrillation would in a patient with a pulse.

Defibrillation is reserved for VT without a pulse (or for ventricular fibrillation) because it’s an unsynchronized shock that can be harmful if the heart is beating. Pacemaker insertion isn’t an immediate fix for an acute VT episode; it’s a long-term device therapy used for chronic rhythm problems or certain conduction issues. Immediate CPR without rhythm correction isn’t appropriate when there is a pulse, since the priority is to terminate the VT and restore adequate rhythm rather than chest compressions alone.