If IO/IV access present, give adenosine 0.1 mg/kg rapid bolus (maximum first dose 6 mg) May give second dose of 0.2 mg/kg rapid bolus (maximum second dose 12 mg) Or if no IO/IV access or adenosine ineffective, synchronized cardioversion

This Algorithm is based on the latest (2015) American Heart Association standards and guidelines.

P E D I A T R I C T A C H Y C A R D I A W I T H A P U L S E A N D P O O R P E R F U S I O N A L G O R I T H M

Probable sinus tachycardia

Compatible history consistent with known cause

IDENTIFY AND TREAT

UNDERLYING CAUSE

MAINTAIN PATENT AIRWAY Assist breathing as necessary

OXYGEN

Monitor blood pressure and oximetry CARDIAC MONITOR TO IDENTIFY RHYTHM

12-LEAD ECG IF AVAILABLE Don’t delay therapy

EVALUATE QRS DURATION EVALUATE RHYTHM QRS NARROW (≤0.09 sec)

QRS WIDE (>0.09 sec)

P waves present/normal

Variables R-R with constant PR

Infants: rate usually <220/min

Children: rate usually <180/min

Probable supraventricular tachycardia

Compatible history (vague, nonspecific; history of abrupt rate changes) P waves absent/abnormal HR not variable with activity

Infants: rate usually ≥220/min Children: rate usually ≥180/min

Cardiopulmonary Compromise?

Acutely altered mental state

Signs of shock

Synchronized cardioversion Search for and treat cause Consider vagal maneuvers

IO/IV ACCESS

Use 12-lead ECG or monitor

Do Not Delay

Possible Ventricular Tachycardia

Hypotension

Consider Adenosine

If rhythm regular and QRS monomorphic

NO YES

Expert consultation Recommended

Amiodarone

Procainamide

Synchronized Cardioversion

Start with 0.5 – 1 J/kg: • If ineffective, increase to 2 J/kg • Do not delay cardioversion; sedate if needed

Amiodarone or Procainamide IO/IV Dose

DOSES & DETAILS

Amiodarone and procainamide should not be routinely administered together Amiodarone I/IV Dose: • 5mg / kg over 20-60 minutes Procainamide IO/IV Dose: • 15mg / kg over 30-60 minutes

Establish vascular access Consider adenosine 0.1 mg/kg IV (maximum first dose 6 mg) May give second dose of 0.2 mg/kg IV (maximum second dose 12 mg) Use rapid bolus technique

This Algorithm is based on the latest (2015) American Heart Association standards and guidelines.

P E D I A T R I C T A C H Y C A R D I A W I T H A P U L S E A N D A D E Q U A T E P E R F U S I O N A L G O R I T H M

Probable sinus tachycardia

Compatible history consistent with known cause

IDENTIFY AND TREAT

UNDERLYING CAUSE

MAINTAIN PATENT AIRWAY Assist breathing as necessary

OXYGEN

Monitor blood pressure and oximetry CARDIAC MONITOR TO IDENTIFY RHYTHM

12-LEAD ECG IF AVAILABLE Don’t delay therapy

EVALUATE QRS DURATION EVALUATE RHYTHM EVALUATE RHYTHM QRS NORMAL

(≤0.09 sec) QRS WIDE (≥0.09 sec)

P waves present/normal

Variables R-R with constant PR

Infants: rate usually <220/min Children: rate usually <180/min

Probable supraventricular tachycardia

Compatible history (vague, nonspecific; history of abrupt rate changes) P waves absent/abnormal

HR not variable with activity

Infants: rate usually ≥220/min Children: rate usually ≥180/min

Possible supraventricular tachycardia (with QRS

aberrancy)

R-R interval regular

Uniform QRS morphology

Probable ventricular tachycardia

Search for and treat cause Consider vagal maneuvers

Expert consultation strongly recommended Search for and treat reversible causes Obtain 12-lead ECG Consider pharmacologic conversion

- Amiodarone 5 mg/kg IV over 20 to 60 minutes OR

- Procainamide 15 mg/kg IV over 30 to 60 minutes

- Do not routinely administer amiodarone and procainamide together

- May attempt adenosine if not already administered

Consider electrical conversion - Consult pediatric cardiologist - Attempt cardioversion with 0.5 to 1

J/kg (may increase to 2 J/kg if initial dose ineffective)

- Sedate before cardioversion