Your 66-year-old male patient is experiencing crushing chest pain and has a BP of 80/64. He is in VTACH at a rate of 176. How should you treat this patient?

In this scenario, the patient is experiencing ventricular tachycardia (VTACH) with a pulse and is exhibiting signs of hemodynamic instability, evidenced by the low blood pressure of 80/64 and the presence of crushing chest pain. The appropriate treatment for this patient involves synchronized cardioversion, which is indicated for stable or unstable VTACH with a pulse.

The choice of energy level for synchronized cardioversion is critical. Starting at 100 joules is the recommended approach for pulse-generating VTACH. This energy setting is generally effective in converting the arrhythmia while minimizing the risk of further complications or harm to the patient during the procedure. Higher energy levels can be reserved for further attempts or for situations where lower levels fail to achieve conversion.

While lower energy levels are typically used for synchronizing cardioversion in other arrhythmias, for VTACH with hemodynamic compromise, beginning treatment at 100 joules maximizes the chance of success and ensures the patient's safety.

Choosing the higher energy level of 50 joules would be insufficient in this critical setting due to the severity of the patient's condition. Additionally, options that suggest amiodarone infusion or defibrillation do not align with the immediate need for rapid intervention in