Unstable wide-complex tachycardia should be treated with which intervention?

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When wide-complex tachycardia is accompanied by signs of instability, the priority is to restore perfusion quickly with synchronized cardioversion. The synchronized shock is timed to the QRS complex to prevent delivering a shock during the vulnerable part of the cycle, which helps avoid inducing ventricular fibrillation and gives the heart a chance to reestablish a stable rhythm. This approach is favored because adenosine and vagal maneuvers are not reliably effective for ventricular tachycardia and can delay definitive treatment, and defibrillation is reserved for pulseless VT or ventricular fibrillation. Start with a dose of 0.5-1 J/kg, and if needed, escalate to 1-2 J/kg (and higher per protocol) to achieve rhythm control. In unstable patients, rapid coordination of airway, breathing, circulation, and sedation as appropriate complements this lifesaving intervention.