Page 55 - 2023 SMOG Digital

Cardiac

PEDIATRIC TACHYCARDIA with
Pulse and Adequate Perfusion

Typical HR/min Indicators of CARDIOPULMONARY COMPROMISE
• Newborn 85–205 • Hypotension
• 3mo–2y/o 100–190 o 1–10 y/o lower limit = 70+(years oldx2)mmHg
• 2y/o–10y/o 60–140 o >10 y/o lower limit = 90mmHg
• >10y/o 60–100 • Acutely Altered Mental Status
Typical Sinus Tachycardia Rates o GCS <8, Weak Cry, Unusual Irritability, Altered
• Infants <220/min Responsiveness, Lethargy, or Failure to Respond to
• Children <180/min Painful Stimulus
• Signs of Shock
Identify and Treat Underlying Cause!
Continue: Wide QRS?
Universal Patient Care Guideline QRS Width? >0.09 Second Uniform QRS?
• Maintain Airway / Assisted Breathing
• O2 (Titrate to 94-99% SpO2) YES NO
• IV/IO access (IV Guideline) Narrow QRS? Possible
• Monitor and 12-Lead ECG (ASAP) <0.09 Second Supraventricular
Probable
• Check Glucose Tachycardia Ventricular
Tachycardia
• Heart Rate?:
o Infants: Typically >220/min
Probable Sinus Tachycardia o Child: Typically >180/min • Expert Consultation ASAP
• Search for and Treat NO o Constant Rate w/o variability on 6 second strip • Search for and Treat
Underlying Causes o Abrupt Rate changes between tachy and normal Underlying Causes
• P waves absent or abnormal? • 12-Lead ECG
• Vague history inconsistent with known cause
Treatable causes: YES Consider Chemical Conversion:
• Check & Treat Compromise in ABCs Amiodarone 5mg/kg over
• Hypoglycemia Probable 20––60 minutes IV/IO
o D25 2mL/kg slow IV (max 25mL) Supraventricular Tachycardia
o Glucagon 0.025mg/kg IM (max 1mg) • Consider Vagal Maneuvers
• Tension Pneumothorax with NO delay to next step
OVERDOSE : If NOT Already Administered:
• B-blocker (atenolol, metoprolol, labetalol): Adenosine IV/IO Rapid Push *Adenosine IV / IO Rapid Push
o Glucagon 0.05mg/kg (3–10mg) IV–pretreat with 1 st 0.1mg/kg (max 6mg) 1 st 0.1mg/kg (max 6mg)
ondansetron (0.15mg/kg–max 2mg) for nausea if 2 nd 0.2mg/kg (max 12mg) 2 nd 0.2mg/kg (max 12mg)
possible. Consider:
• Calcium Channel Blocker (dilitiazem, verapamil, Fails to Convert Synchronized Cardioversion
nifedipine) 1 st 0.5–1J/kg, if fails then 2J/kg
o Calcium gluconate 10% 0.2ml/kg slow IV push. (Sedation before Cardioversion:
• Narcotic Midazolam 0.05–0.1mg/kg IV/IO)
o Naloxone 0.1mg/kg IV/IM (max 2mg)
Pearls:
• Vagal maneuvers: blow through 18ga IV catheter, ice pack on forehead, carotid massage (unilateral only –
listen for bruits prior to performing), or having patient blow against closed glottis (“bear down”).
• *Adenosine should be as central as possible with the “2 syringe technique” – one with adenosine and
the other with the saline flush. These should be attached to a 2 port IV adapter and flush should
immediately follow drug.
• *Adenosine should be utilized in monomorphic and regular R-R interval type presentation.
• All patients should be warned of discomfort/feeling of heart stopping before adenosine administration.
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