Page 56 - 2023 SMOG Digital

Cardiac

PEDIATRIC TACHYCARDIA with
Pulse and Poor Perfusion

Typical HR/min Indicators of CARDIOPULMONARY COMPROMISE
• Newborn 85–205 • Hypotension
• 3mth–2y/o 100–190 o 1–10y/o lower limit = 70+(years old X 2)mmHg
• 2y/o–10y/o 60–140 o >10y/o lower limit = 90mmHg
• >10 y/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:
Possible
Wide QRS?
Universal Patient Care Guideline QRS Width? >0.09 Second Ventricular Tachycardia
• Maintain Airway / Assisted Breathing
• O2 (Titrate to 94-99% SpO2)
• IV / IO access (IV Guideline) Narrow QRS?
• Monitor and 12-Lead ECG (ASAP) <0.09 Second Cardiopulmonary
• Check Glucose YES Compromise?
• Heart Rate?: NO
o Infants: Typically >220/min
Probable Sinus Tachycardia o Child: Typically >180/min If Regular Rhythm (R-R) and
• Search for and Treat NO o Constant Rate w/o variability on 6 second strip QRS Monomorphic:
Underlying Causes o Abrupt Rate changes between tachy and normal Adenosine IV / IO Rapid Push
• P waves absent or abnormal? 1 st 0.1mg/kg (max 6mg)
• Vague history inconsistent with known cause 2 nd 0.2mg/kg (max 12mg)
YES
Treatable causes: Probable Amiodarone 5mg/kg over 20-
• Check & Treat compromise in ABCs Supraventricular Tachycardia 60 minutes IV/IO
• Hypoglycemia • Consider Vagal Maneuvers
o D25 2mL/kg slow IV (max 25mL) with NO delay to next step OR
o Glucagon 0.025mg/kg IM (max 1mg) Procainamide 15mg/kg over
• Tension Pneumothorax 30––60 minutes
OVERDOSE (Breastfeeding Mother): Adenosine IV/IO Rapid Push
1 st 0.1mg/kg (max 6mg)
• B-blocker (atenolol, metoprolol, labetalol): 2 nd 0.2mg/kg (max 12mg)
o Glucagon 0.05mg/kg (3-10mg) IV – pretreat with
ondansetron (0.15mg/kg – max 2mg) for nausea if possible If no IV/IO access or adenosine fails
• Calcium channel blocker (dilitiazem, verapamil, nifedipine) Synchronized Cardioversion
o Calcium chloride 10% 0.2ml/kg slow IV push 1 st 0.5-1J/kg, if fails then 2J/kg
• Narcotic (Sedation w/o delay to Cardioversion:
o Naloxone 0.1mg/kg IV/IM (max 2mg) Midazolam 0.05-0.1mg/kg IV/IO)
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 given 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.
• All patients should be warned of discomfort/feeling of heart stopping before adenosine administration.
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