A 60-year-old woman with bipolar disorder presented to a local hospital after being found unresponsive at home. When assessed by emergency medical services, she was found to be tachycardic to 180 beats per minute and received 3 doses of adenosine on transport with no effect. Given concern for altered mental status, she was intubated for airway protection. In the emergency department, the patient’s rhythm was described as a wide complex tachycardia. She was found to be hypotensive, leading to multiple attempted cardioversions at 100, 200, and 360 J (twice).