Systematic approach algorithm addressing increased heart rate, including SVT and VT in the pediatric patient. Includes drug dosages and shock energies for cardioversion.
Tachycardia (Tachyarrhythmia) is defined as a rhythm with a heart rate greater than 100 bpm. The systematic approach algorithm is used to direct the care of the critically-ill or injured child. However, once it is recognized that an infant or child is experiencing symptomatic tachycardia, the tachycardia algorithms are used to simplify and streamline the evaluations and interventions to be carried out. Once tachycardia is recognized, the decision pathway includes two questions that are outlined in the algorithm diagram.
Step 1. Initial assessment and support
Step 2. Evaluate rhythm with 12 lead ECG or monitor.
Step 3. Is there cardiopulmonary compromise? Manifested by:
Step 4. If yes, evaluate QRS duration. If < .09 seconds , probable Supraventricular Tachycardia (SVT). If no, proceed to step 8.
Step 5. If IV/IO access is present, give adenosine, or if IV/IO access not available, or if adenosine is ineffective, perform synchronized cardioversion.
Step 6. Return to Step 4. If QRS >.09 seconds, rhythm is possibly ventricular tachycardia (VT).
Step 7. Perform synchronized cardioversion. Expert consultation is advised before additional drug therapies.
Step 8. (No Cardiopulmonary Compromise) Evaluate QRS duration. If narrow (< .09 sec), rhythm is probable Supraventricular Tachycardia (SVT):
Step 9. Consider vagal maneuvers. If IV/IO access is present, give adenosine.
Step 10. If QRS duration is wide (> .09 sec), rhythm is possible ventricular tachycardia. If rhythm is regular and QRS is monomorphic, consider amiodarone. Expert consultation is recommended.
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