Pediatric Tachycardia Administrative Guideline (Age < 14)

Question 1

History

Answer 1

• Past medical history
• Medications or Toxic Ingestion
• Drugs (nicotine, cocaine)
• Congenital Heart Disease
• Respiratory Distress
• Syncope or Near Syncope

Question 2

Signs and symptoms

Answer 2

- Heart Rate: (Child >180/bpm, Infant > 
220/bpm)
- Pale/cyanotic/diaphoretic
- Hypotension/ALOC
- Pulmonary congestion/tachypnea
- Syncope

Question 3

Differential

Answer 3

• Heart disease (Congenital)
• Hypo/Hyperthermia
• Hypovolemia or Anemia
• Anxiety / Pain / Emotional stress
• Fever / Infection / Sepsis
• Hypoxia, Hypoglycemia
• Medication / Toxin / Drugs (see HX)
• Trauma

Question 4

Tachycardia with serious symptoms (hypotension, poor perfusion, or ALOC)

Answer 4

Cardioversion for shockable rhythm:
0.5 J / kg for shock #1, 
- Increase to 1 J/kg, repeat if needed
- Increase to 2 J/kg (max 360 J) and 
repeat shock
Consider Sedation:  
- Midazolam 0.1 mg/kg  IV/IO/IM/IN 
(max 2.5 mg initial dose)
- May repeat if needed to maximum 
5 mg IV/IO/IM/IN

Question 5

Tachycardia steps any type

Answer 5

Administer O 2  to maintain Sat >94%
Vital sign assessment, including 
temperature if available
IV/IO access, O 2 , cardiac monitor, 12 
lead ECG

Question 6

Narrow complex
0.08s or less
Sinus tach

Answer 6

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

Question 7

Narrow complex 
 0.08s or less
SVT
Infants usually >220 bpm
Children usually >180 bpm

Answer 7

Age specific vagal maneuvers 
Consider 20 mL/kg NS/LR bolus 
with reassessment every 100 mL
Administer adenosine  0.1 mg/kg 
adenosine IV/IO (max 6 mg) 
followed by 10 mL saline flush
May repeat x 1 at 0.2 mg/kg (max  
12 mg)

If no response or history or WPW
Administer amiodarone 5 mg/kg
(max 150 mg) over 20 minutes

Question 8

Wide complex

>0.08 sec

Answer 8

Consider SVT with aberrancy:
Administer adenosine  0.1 mg/kg 
adenosine IV/IO (max 6 mg) 
May repeat x 1 at 0.2 mg/kg 
adenosine IV/IO (max  12 mg)
Always follow with 10 mL flush
If no response or VT or WPW is 
considered: 
Administer amiodarone 5 mg/kg 
(max 150 mg)  over 20 minutes

Question 9

Ooo… what if its Torsades de Pointes??

Answer 9

Administer magnesium sulfate 25

mg/kg IV/IO over 10 minutes

Question 10

What happens when get a conversion of rhythm

Answer 10

12 lead EKG, repeat vital signs, monitor

Notify receiving facility or contact Medical Direction

Question 11

Age appropriate vagal maneuvers are?

Answer 11

• Breath holding.
• 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 12

Other notes on peds

Answer 12

• Separating the child from the caregiver may worsen the child’s clinical condition. (Duh)
• Pediatric paddles should be used in children < 10 kg or Broselow-Luten color Purple if available.
• Monitor for respiratory depression and hypotension associated if Midazolam is used to facilitate
  cardioversion.
• Document all rhythm changes with monitor strips and obtain monitor strips with each therapeutic
  intervention.