If IO/IV access present, give adenosine 0.1 mg/kg rapid bolus (maximum first dose 6 mg) May give second dose of 0.2 mg/kg rapid bolus (maximum second dose 12 mg) Or if no IO/IV access or adenosine ineffective, synchronized cardioversion
This Algorithm is based on the latest (2015) American Heart Association standards and guidelines.
P E D I A T R I C T A C H Y C A R D I A W I T H A P U L S E A N D P O O R P E R F U S I O N A L G O R I T H M
Probable sinus tachycardia
Compatible history consistent with known cause
IDENTIFY AND TREAT
UNDERLYING CAUSE
MAINTAIN PATENT AIRWAY Assist breathing as necessary
OXYGEN
Monitor blood pressure and oximetry CARDIAC MONITOR TO IDENTIFY RHYTHM
12-LEAD ECG IF AVAILABLE Don’t delay therapy
EVALUATE QRS DURATION EVALUATE RHYTHM QRS NARROW (≤0.09 sec)
QRS WIDE (>0.09 sec)
P waves present/normal
Variables R-R with constant PR
Infants: rate usually <220/min
Children: rate usually <180/min
Probable supraventricular tachycardia
Compatible history (vague, nonspecific; history of abrupt rate changes) P waves absent/abnormal HR not variable with activity
Infants: rate usually ≥220/min Children: rate usually ≥180/min
Cardiopulmonary Compromise?
Acutely altered mental state
Signs of shock
Synchronized cardioversion Search for and treat cause Consider vagal maneuvers
IO/IV ACCESS
Use 12-lead ECG or monitor
Do Not Delay
Possible Ventricular Tachycardia
Hypotension
Consider Adenosine
If rhythm regular and QRS monomorphic
NO YES
Expert consultation Recommended
Amiodarone
Procainamide
Synchronized Cardioversion
Start with 0.5 – 1 J/kg: • If ineffective, increase to 2 J/kg • Do not delay cardioversion; sedate if needed
Amiodarone or Procainamide IO/IV Dose
DOSES & DETAILS
Amiodarone and procainamide should not be routinely administered together Amiodarone I/IV Dose: • 5mg / kg over 20-60 minutes Procainamide IO/IV Dose: • 15mg / kg over 30-60 minutes
Establish vascular access Consider adenosine 0.1 mg/kg IV (maximum first dose 6 mg) May give second dose of 0.2 mg/kg IV (maximum second dose 12 mg) Use rapid bolus technique
This Algorithm is based on the latest (2015) American Heart Association standards and guidelines.
P E D I A T R I C T A C H Y C A R D I A W I T H A P U L S E A N D A D E Q U A T E P E R F U S I O N A L G O R I T H M
Probable sinus tachycardia
Compatible history consistent with known cause
IDENTIFY AND TREAT
UNDERLYING CAUSE
MAINTAIN PATENT AIRWAY Assist breathing as necessary
OXYGEN
Monitor blood pressure and oximetry CARDIAC MONITOR TO IDENTIFY RHYTHM
12-LEAD ECG IF AVAILABLE Don’t delay therapy
EVALUATE QRS DURATION EVALUATE RHYTHM EVALUATE RHYTHM QRS NORMAL
(≤0.09 sec) QRS WIDE (≥0.09 sec)
P waves present/normal
Variables R-R with constant PR
Infants: rate usually <220/min Children: rate usually <180/min
Probable supraventricular tachycardia
Compatible history (vague, nonspecific; history of abrupt rate changes) P waves absent/abnormal
HR not variable with activity
Infants: rate usually ≥220/min Children: rate usually ≥180/min
Possible supraventricular tachycardia (with QRS
aberrancy)
R-R interval regular
Uniform QRS morphology
Probable ventricular tachycardia
Search for and treat cause Consider vagal maneuvers
Expert consultation strongly recommended Search for and treat reversible causes Obtain 12-lead ECG Consider pharmacologic conversion
- Amiodarone 5 mg/kg IV over 20 to 60 minutes OR
- Procainamide 15 mg/kg IV over 30 to 60 minutes
- Do not routinely administer amiodarone and procainamide together
- May attempt adenosine if not already administered
Consider electrical conversion - Consult pediatric cardiologist - Attempt cardioversion with 0.5 to 1
J/kg (may increase to 2 J/kg if initial dose ineffective)
- Sedate before cardioversion