Attempt vagal maneuvers (Valsalva maneuver and/or carotid sinus massage)
before drug therapy. Cardioversion (if unstable or refractory to drug therapy):
1. NPO for 6h, digoxin level must be less than 2.4 and potassium and magnesium must be normal.
2. Midazolam (Versed) 2-5 mg IV push.
3. If stable, cardiovert with synchronized 10-50 J, and increase by 50 J incre ments if necessary. If unstable, start with 75-100 J, then increase to 200 J and 360 J.
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