History:

 

• Past medical history
• Medications/toxic ingestion
  • Aminophylline
  • Diet pills
  • Thyroid supplements
  • Decongestants
  • Digoxin
  • Drugs (nicotine/cocaine)
• Congenital heart disease
• Prior history of tachycardia
• Syncope/near syncope
• Respiratory distress

 

Significant findings:

 

• Heart Rate
  • Child >180/bpm
  • Infant >220/bpm
• Pale/cyanotic
• Diaphoresis
• Tachypnea
• Unresponsive
• Hypotension

 

Differential:

 

• Congenital heart disease
• Hypo/hyperthermia
• Hypovolemia/anemia
• Electrolyte imbalance
• Anxiety/pain/emotional stress
• Fever/infection/sepsis
• Hypoxia
• Hypoglycemia
• Medication/toxin (see History)
• Pulmonary embolus
• Trauma
• Tension pneumothorax

 

 Treatment:

 

• Oxygen

• 12-Lead EKG

• Initiate IV/IO

• May attempt valsalva maneuver (ice or cold rag to patient's face)

 

Narrow QRS (<0.08) ?

 

• Yes

 

• • Strongly rule out differential diagnosis (i.e., postictal, fever, etc.)

 

• • OLMC: Adenocard 0.1 mg/kg IV/IO; max 6 mg

 

• • OLMC: Adenocard 0.2 mg/kg IV/IO; max 12 mg

 

• • OLMC: Consider conscious sedation

 

• • OLMC: Cardiovert (synchronized) 0.5-1 J/kg; increase to 2 J/kg if necessary(Medical Control)

 

Wide QRS (>0.08) ?

 

• Yes

 

• • Consider conscious sedation (see PEARLS)

 

• • Cardiovert (synchronized) 0.5-1 J/kg; increase to 2 J/kg if necessary

 

• • Notify receiving facility or contact Medical Control

 

PEARLS:

 

• Pediatric = 1 day to less than age 12, or less than 55 kg in ages 12-18.
• Use Handtevy for drug dosages.
• Carefully distinguish sinus tach, SVT, and V-tach. Rule of thumb: the maximum sustainable sinus tach rate is 220 minus the patient's age in years.
• Tachycardia in pediatrics is normally caused by hypoxia or hypovolemia. Identify and treat underlying causes.
• For conscious sedation administer Midazolam (Versed) 2.5 mg/0.5 mL IM if less than 13 kg; if greater than 13 kg administer Midazolam (Versed) 5 mg/1 mL IM; if IV obtained, adminster Lorazepam (Ativan) 0.1 mg/kg IV; max 2 mg.

• Separating the child from the caregiver may worsen the child's clinical condition.
• Pediatric paddles should be used in children less than 10 kg or color purple
• Document all rhythm changes with monitor strips and obtain monitor strips with each therapeutic intervention.