Pediatric Tachycardia

Question 1

Pediatric Tachycardia - Probable sinus tachycardia criteria

Answer 1

Gradual onset
Compatible Hx
P waves present/normal
Infant rate <220
Child rate <180

Question 2

Pediatric Tachycardia - Probable SVT criteria

Answer 2

Abrupt onset
HR does not change with activity
P waves absent/abnormal
Infant rate >220
Child rate >180

Question 3

Pediatric Tachycardia - Probable sinus tachycardia treatment

Answer 3

Search for and treat cause

Question 4

Pediatric Tachycardia - Stable SVT treatment

Answer 4

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

Question 5

Pediatric Tachycardia - Adenosine precaution

Answer 5

Do not administer if pt taking carBAMazepine (Tegretol) or dipyridamole (Persantine)

Question 6

Pediatric Tachycardia - Stable VT treatment

Answer 6

Mandatory OLMC:

Consider Amiodarone 5 mg/kg. single max of 300mg

Question 7

Pediatric Tachycardia - Stable polymorphic VT treatment

Answer 7

Mandatory OLMC:

Consider Magnesium 50 mg/kg, single max of 2g

Question 8

Pediatric Tachycardia - Unstable SVT 1st line treatment

Answer 8

Vagal maneuver
Adenosine 0.1 mg/kg, single max of 6mg, then
Adenosine 0.2 mg/kg, single max of 12mg

Question 9

Pediatric Tachycardia - Unstable SVT 2nd line treatment

Answer 9

Mandatory OLMC:

Cardioversion 1 J/kg then 2 J/kg

Question 10

Pediatric Tachycardia - Unstable SVT 3rd line treatment

Answer 10

Mandatory OLMC:

Amiodarone 5 mg/kg, Single max of 300 mg

Question 11

Pediatric Tachycardia - Unstable monomorphic VT 1st line treatment

Answer 11

Mandatory OLMC:

Cardioversion 1 J/kg then 2 J/kg

Question 12

Pediatric Tachycardia - Unstable monomorphic VT 2nd line treatment

Answer 12

Mandatory OLMC:

Amiodarone 5 mg/kg, Single max of 300 mg

Question 13

Pediatric Tachycardia - Unstable polymorphic VT 1st line treatment

Answer 13

Defibrillate 2 J/kg x 1

Question 14

Pediatric Tachycardia - Unstable polymorphic VT 2nd line treatment

Answer 14

Consider Magnesium 50 mg/kg, single max of 2 g

Question 15

Pediatric Tachycardia - Unstable polymorphic VT 3rd line treatment

Answer 15

Defibrillate 4 J/kg x 1

Question 16

Pediatric Tachycardia - Adenosine indications

Answer 16

SVT

Question 17

Pediatric Tachycardia - Adenosine dose

Answer 17

0.1 mg/kg single max of 6 mg, then 0.2 mg/kg single max of 12 mg

Question 18

Pediatric Tachycardia - Adenosine EMS contraindications

Answer 18

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)

Question 19

Pediatric Tachycardia - Amiodarone indications

Answer 19

SVT or VT

Question 20

Pediatric Tachycardia - Amiodarone dose

Answer 20

5 mg/kg IV/IO to a single max of 300 mg. No repeat

Question 21

Pediatric Tachycardia - Amiodarone administration

Answer 21

5 mg/kg in 250 mL D5W with 60 gtt set and inline filter over 60 minutes

Question 22

Pediatric Tachycardia - Amiodarone EMS contraindications

Answer 22

Hypersensitivity
Cardiogenic shock
2nd or 3rd degree AV block
Cardiovascular collapse
Patients predisposed to intracranial hypertension
Acute hepatitis
Thyroid dysfunction
Interstitial pulmonary disease

Question 23

Pediatric Tachycardia - Amiodarone precautions

Answer 23

Do not exceed 30 mg/minute
Must be diluted prior to administration
Observe for signs of pulmonary toxicity

Question 24

Pediatric Tachycardia - Amiodarone signs of pulmonary toxicity

Answer 24

progressive apnea
cough
fever
pleuritic pain

Question 25

Pediatric Tachycardia - Magnesium indications

Answer 25

Polymorphic VT

Question 26

Pediatric Tachycardia - Magnesium dose

Answer 26

50 mg/kg IV/IO to a single maximum dose of 2 g. No repeat

Question 27

Pediatric Tachycardia - Magnesium administration

Answer 27

50 mg/kg in 50 mL NS and over 20 minutes

Question 28

Pediatric Tachycardia - Magnesium EMS contraindications

Answer 28

Any degree of heart block

Renal failure

Question 29

Pediatric Tachycardia - Magnesium precautions

Answer 29

May cause respiratory depression; monitor vital signs closely post administration