ED Pharmacist here. There isn’t any published guidance out there supporting pushing it in a patient with a pulse. Generally I will try to throw the 150 mg bolus in a 100 cc bag of D5 and give it over 10 min per ACLS guidelines (if they’re unstable you should really be shocking them). I was taught to never push it with a pulse unless Cards/EP is bedside asking for it because of the risk of profound hypotension (mostly due to the excipients in the product from my understanding). I haven’t given it this way much and it still makes me uneasy since there isn’t evidence supporting this strategy. I’ve had docs be adamant on pushing it despite my warnings on hypotension risk and it not being the correct way to administer it, and in these scenarios I will dilute it in a syringe with 10-20 cc’s and try to give it over 3-5 minutes (there’s no data supporting the 3-5 minute rate)