Ped's Tachycardia

Question 1

Unstable Tachycardia..

Answer 1

Cardioversion:

1st Shock: 0.5 J/kg
2nd Shock: 1 J/kg
Subsequent Shocks: 2 J/kg (max 200 J)

Consider Sedation:
- Midazolam 0.1 mg/kg IV/IO/IM
(max 2.5 mg initial dose)
- May repeat if needed to maximum
dose of midazolam 5 mg IV/IO/IM/IN

Question 2

Stable Tachycardia..

Answer 2

• Administer O2 to maintain SPO2 >94%
• Assess All Vitals (Including 12 lead)
• Obtain IV Access

Question 3

If Sinus Tach..

Answer 3

• Identify and treat underlying cause
• Consider 20 mL/kg fluid bolus
  with reassessment every 100 mL
  for signs of fluid overload.

Question 4

If SVT..

Answer 4

• Attempt Vagal Maneuvers
• Consider 20 mL/kg of Fluid w/ reassessment every 100 mL
• Adenosine 0.1 mg/kg
  in proximal IV (6mg MAX)
  *May repeat @ 0.2
  mg/kg (12 mg MAX)
  follow by 10 mL saline flush

If no response or HX of WPW:
- Administer Amiodarone 5 mg/kg Drip (150mg MAX)

Question 5

If Wide Complex..

Answer 5

• Attempt Vagal Maneuvers

Consider SVT with aberrancy:
- Administer Adenosine 0.1 mg/kg
in proximal IV (6 mg MAX)
*May repeat @ 0.2mg/kg (12 mg MAX) follow by 10 mL saline flush

If no response or VT or no HX
- Administer Amiodarone 5 mg/kg
IV/IO (max 150 mg) over 20
minutes

Question 6

If Torsades..

Answer 6

• Administer Mag Drip 25mg/kg (2g MAX) over 15 minutes

Cardiac arrest:
Slow IVP over 2-3min

Question 6

Vagal Maneuvers

Answer 6

• Breath holding
• Ice on Face
• Blowing a glove into a balloon
• Have child blow out “birthday candles” or through an obstructed straw

Infants:
- May put a bag of ice water over the upper half of the face, using care not to occlude the airway

Question 7

If Rhythm Converts..

Answer 7

• 12 lead ECG
• Repeat vital signs
• Monitor
• Notify receiving facility or contact Medical Direction

Question 8

If Apneic or Pulseless @ any time..

Answer 8

Follow Cardiac Arrest AG