A 46-year-old woman with Wolff-Parkinson-White syndrome is admitted to the hospital because of a 24-hour history of abdominal pain. She reports that over the past 24 hours she had the acute onset of pain, which has gradually worsened. The pain is located in her right upper quadrant and radiates to the umbilicus. She takes no medications. She states how she "feels her heart race" often, but usually by holding her breath and baring down, it slows. A diagnosis of acute cholangitis is made and the patient is admitted to the intensive care unit. While there, the alarm sounds at the nurse's station where she is seen to be in a tachycardia with a heart rate of 250 /min. On arrival to the room, her pulse is regular at 240-260 /min and her blood pressure is nonpalpable. The patient is not responsive. A 12 lead electrocardiogram reveals a supraventricular tachycardia at 220/min. Chest compressions are begun. At this time you should
A. give intravenous amiodarone
B. give intravenous metoprolol
C. give intravenous verapamil
D. perform synchronized cardioversion
E. perform unsynchronized cardioversion
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