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Pediatric Tachycardia Algorithms

This algorithm provides guidance for treating pediatric tachycardia based on electrocardiogram findings and the patient's condition. It evaluates whether the QRS duration is normal or wide, and whether signs point to sinus tachycardia, supraventricular tachycardia, or ventricular tachycardia. For stable patients it considers vagal maneuvers, adenosine, or medications like amiodarone. For unstable patients it recommends immediate cardioversion or expert consultation along with treating any underlying causes like hypoxemia. The algorithm aims to safely and quickly identify and treat the underlying rhythm disturbance.

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Galih Fatoni
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368 views1 page

Pediatric Tachycardia Algorithms

This algorithm provides guidance for treating pediatric tachycardia based on electrocardiogram findings and the patient's condition. It evaluates whether the QRS duration is normal or wide, and whether signs point to sinus tachycardia, supraventricular tachycardia, or ventricular tachycardia. For stable patients it considers vagal maneuvers, adenosine, or medications like amiodarone. For unstable patients it recommends immediate cardioversion or expert consultation along with treating any underlying causes like hypoxemia. The algorithm aims to safely and quickly identify and treat the underlying rhythm disturbance.

Uploaded by

Galih Fatoni
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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----

~------------~.~-~

Algorithm for Pediatric


With Poor Perfusion

'

'--'

'--.------.--

; Algorithm

Tachycardia

for Pediatric Tachycardia


With Adequate Perfusion
..

BLS Algorithm: Assess and support ABCs (assess signs


of circulation and pulse; provide oxygen and ventilation
as needed)
0 !,rovide oxygen
oAltacn monitor/defibrillator
0 Evaluate 12-lead
ECG if practical
0

QRS duration nonnal for age


(approximately SO.08 sec)

QRS duration wide for age


(approximately
>0.08 sec)

What is the QRS duration?


QRS duration nonnal for age
(approximately ".08 see)

QRS duration wide for age


(approximately >0.08 sec)

Identify
possible
0

'P';"bal)J't;";\1ip":;;vent"iOO1ti.,'
"tachycardia

and ti"!;*lt
causes

: 0 History incompatible

'i. f'. waves absent/abnonmal


HR not variable with

Hypoxemia

..

.'

>220
pm
',' Children: rate usually
>180 bpm

Probable sinus
tachycardia
0
0

Prob'ables~praventricular
tachycardia

History compatible
P waves
present/normal

0
0

+,IRoften varies with


activity
Variable RR with

Probable ventricular tachycardia


0 Immediate cardioversion

Historyincompatible

0.5 to 1.0 J/kg


(consider sedation,
cardioversion)

P waves absent/abnormal
HR not variable with activity

oAbruptratechange~

Infants: rate usually >220' bPm:'


0 Children: rate usually> 180 bpm

:
Consider alternative medications

Infants:rateusually
<220 bpm

Children: rate usually

,,'0 Amiodarone 5 mglkg IV


over 20tc:~0 mi~utes
or
0 Procainamide 15 mglkg

<180 bpm

Immediate cardioversion or
0 Attempt cardioversion with
0.5,-10

to 2

1,0 J/kg

J/kg

Immediate
0

ineffective)
0

Usesedationifpossible

Sedation must not delay

Adenosine: use if IVaccess is


available

Dose: Adenosine 0.1 mg/kg


IV~O (maximum first dose: 6mg)

cardioversion
0

dose:

Technique: use rapid bolus


technique

.
0

Establish, vascular access

Consideradenosine 0',1

.
.

mg/kglV (maximum first


dose: 6 mg)
May double and repeat
dose once (maximum
second dose: 12 mg)
Use rapid,bolusJechnique

Support

only)

Consultpediatric

cardiologist
12-lead ECG

sider

Identify

and

,freat

Hypoxemia

Hypovolemia

possible

causes

and metabolic disorders

.
.

Ten$ion pneumothorax
Toxins/poisons/drugs
Thromboembolism
Pain

Consuit pediatric cardioiogist


Consider cardioversion with 0.5 to 1.0 J/kg
(may increase to 2 J/kg ifinitial dose ineffective)
Sed,atipo:prior to cardioversion
1211aad ECG

..'

sedati;:;n)

ABCs

Amiodarone 5 mg~g IVover


20 to 60 minutes
(Do not routinely administer
amiodarone and procainamide
together)
Or
Procainamide 15 mglkg IV
over 30 to 60 minutes
(Do not routinely administer
amiodarone and procainamide
together)
or
Lidocaine 1 mg/kg N bolus

Confirm continuous monitor/pacer attached


Consider expert consultation
Prepare,Jor pardioversion 0.5 to 1.0'J/kg (con-

Lidocaine 1 mg/kg
IV bolus
(wide-complex

Maydoubleand repeatdose
once (maximum second
12O1g)

"

IV over 30 to 50 minutes
(Do not routineiy administer amiodarone and procainamide together)
or

IV/IO Adenosine

immediately

(may,increase

if,Initial dose is

do not delay

During' evalu"lion
Provide oxYgen and ventilation as needed

..

Consider vagal maneuvers

constant PR
0

Consider altemlltive medications

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