Pediatric Tachycardia Flashcards
Pediatric Tachycardia - Probable sinus tachycardia criteria
Gradual onset Compatible Hx P waves present/normal Infant rate <220 Child rate <180
Pediatric Tachycardia - Probable SVT criteria
Abrupt onset HR does not change with activity P waves absent/abnormal Infant rate >220 Child rate >180
Pediatric Tachycardia - Probable sinus tachycardia treatment
Search for and treat cause
Pediatric Tachycardia - Stable SVT treatment
Vagal maneuver
Mandatory OLMC:
Adenosine 0.1 mg/kg, max single dose of 6 mg then
Adenosine 0.2 mg/kg, max single dose of 12 mg
Pediatric Tachycardia - Adenosine precaution
Do not administer if pt taking carBAMazepine (Tegretol) or dipyridamole (Persantine)
Pediatric Tachycardia - Stable VT treatment
Mandatory OLMC:
Consider Amiodarone 5 mg/kg. single max of 300mg
Pediatric Tachycardia - Stable polymorphic VT treatment
Mandatory OLMC:
Consider Magnesium 50 mg/kg, single max of 2g
Pediatric Tachycardia - Unstable SVT 1st line treatment
Vagal maneuver
Adenosine 0.1 mg/kg, single max of 6mg, then
Adenosine 0.2 mg/kg, single max of 12mg
Pediatric Tachycardia - Unstable SVT 2nd line treatment
Mandatory OLMC:
Cardioversion 1 J/kg then 2 J/kg
Pediatric Tachycardia - Unstable SVT 3rd line treatment
Mandatory OLMC:
Amiodarone 5 mg/kg, Single max of 300 mg
Pediatric Tachycardia - Unstable monomorphic VT 1st line treatment
Mandatory OLMC:
Cardioversion 1 J/kg then 2 J/kg
Pediatric Tachycardia - Unstable monomorphic VT 2nd line treatment
Mandatory OLMC:
Amiodarone 5 mg/kg, Single max of 300 mg
Pediatric Tachycardia - Unstable polymorphic VT 1st line treatment
Defibrillate 2 J/kg x 1
Pediatric Tachycardia - Unstable polymorphic VT 2nd line treatment
Consider Magnesium 50 mg/kg, single max of 2 g
Pediatric Tachycardia - Unstable polymorphic VT 3rd line treatment
Defibrillate 4 J/kg x 1
Pediatric Tachycardia - Adenosine indications
SVT
Pediatric Tachycardia - Adenosine dose
0.1 mg/kg single max of 6 mg, then 0.2 mg/kg single max of 12 mg
Pediatric Tachycardia - Adenosine EMS contraindications
Hypersensitivity Pre-existing 2nd / 3rd degree AV block Sinus node disease (sick sinus syndrome) Symptomatic bradycardia Atrial fibrillation / atrial flutter Active bronchospasm / severe asthma Patient taking carbamazepine (Tegretol) or dipyridamole (Persantine)
Pediatric Tachycardia - Amiodarone indications
SVT or VT
Pediatric Tachycardia - Amiodarone dose
5 mg/kg IV/IO to a single max of 300 mg. No repeat
Pediatric Tachycardia - Amiodarone administration
5 mg/kg in 250 mL D5W with 60 gtt set and inline filter over 60 minutes
Pediatric Tachycardia - Amiodarone EMS contraindications
Hypersensitivity Cardiogenic shock 2nd or 3rd degree AV block Cardiovascular collapse Patients predisposed to intracranial hypertension Acute hepatitis Thyroid dysfunction Interstitial pulmonary disease
Pediatric Tachycardia - Amiodarone precautions
Do not exceed 30 mg/minute
Must be diluted prior to administration
Observe for signs of pulmonary toxicity
Pediatric Tachycardia - Amiodarone signs of pulmonary toxicity
progressive apnea
cough
fever
pleuritic pain
Pediatric Tachycardia - Magnesium indications
Polymorphic VT
Pediatric Tachycardia - Magnesium dose
50 mg/kg IV/IO to a single maximum dose of 2 g. No repeat
Pediatric Tachycardia - Magnesium administration
50 mg/kg in 50 mL NS and over 20 minutes
Pediatric Tachycardia - Magnesium EMS contraindications
Any degree of heart block
Renal failure
Pediatric Tachycardia - Magnesium precautions
May cause respiratory depression; monitor vital signs closely post administration