In unstable narrow complex tachycardia, which action is preferred as the initial step?

• A. Immediate synchronized cardioversion
• B. Expedite transport and analgesia
• C. Administer adenosine
• D. Hydrate with IV fluids

Answer: (B)

In unstable narrow complex tachycardia, the priority is rapid stabilization and getting the patient to definitive care. When a patient is unstable, delays increase the risk of poor perfusion and deterioration. Providing analgesia helps reduce pain and anxiety, which lowers sympathetic stimulation and can improve comfort and cooperation during transport. Getting the patient moving to a facility where definitive treatment (like synchronized cardioversion, if still needed) can be performed safely is the best initial step. Medications like adenosine are used for stable SVTs and aren’t appropriate as the first move in an unstable patient, and simply hydrating with IV fluids doesn’t address the instability.