12 - Pediatrics - Narrow complex tachycardia

Question 1

What Hx, S/S, etc., should you consider for SVT?

Answer 1

History of SVT/abrupt changes to HR
Absent/abnormal p-waves
Regular heart rate
Infant HR over 220 
Child HR over 180

Question 2

What Hx, S/S, etc., should you consider for sinus tachycardia?

Answer 2

History consistent blood/volume loss (diarrhea, vomiting, etc.)
Normal p-waves
Irregular heart rate
Infant HR under 220 
Child HR under 180

Question 3

If cardiopulmonary compromise is present in the narrow complex pediatric patient, what is the intervention?

Answer 3

ELECTRICITY!!!!

Synchronized cardioversion at 1 J/kg, then 2 J/kg

Question 4

If cardiopulmonary compromise is not present in the narrow complex pediatric patient, what is the intervention?

Answer 4

Chemical cardioversion

• 0.1 mg/kg adenosine (max 6mg)
• 0.2 mg/kg adenosine (max 12 mg)

Question 5

What other interventions for the narrow complex tachycardia peds patient may be utilized (aside from chemical and electrical cardioversion)?

Answer 5

• application of ice to face (w/o block airway) in the infant/small child
• Valsalva maneuver in the older child