What action should be taken if wide complex tachycardia is irregularly irregular?

If the wide complex tachycardia is irregularly irregular, it suggests the presence of a condition like atrial fibrillation with a rapid ventricular response or another form of polymorphic ventricular tachycardia that does not have a consistent pattern. In these cases, immediate cardioversion with electricity may not be appropriate because it can lead to further complications or worsen the patient's condition.

The rationale for not cardioverting is based on the nature of the rhythm. In irregular rhythms, especially when it comes to wide complexes, there is a risk that you could worsen the underlying arrhythmia or cause harm. Management instead focuses on assessing the patient’s symptoms, monitoring, and possibly considering antiarrhythmic medications instead.

In contrast, other options like administering adenosine or cardioverting at a specific joule setting are not appropriate for irregular wide complex tachycardia. Adenosine usually works for regular narrow complex tachycardias and is not effective for types of tachycardia characterized by irregularity. Additionally, while CPR is critical in certain arrhythmias, performing it immediately is generally reserved for those with a pulseless rhythm or when the patient is in cardiac arrest, not just for unstable tachycardia.