Pediatric tachycardia Flashcards
What is the definition of narrow complex tachycardia and pediatric patients?
Less than or equal to 9 ms
When is cardioversion and pediatric patient indicated?
What is the initial energy setting for cardioversion in pediatric patients?
Cardioversion as indicated in the case of an unstable patient: altered mental status, congestive heart failure, poor perfusion.
Energy setting: .5 to one j/kg or as indicated by manufacture
Subsequent cardioversion attempts should be done at 2 J/kg or as indicated by manufacture
Always obtain new 12 lead after successful cardioversion. If change occurs, snapshot 4 lead.
What are the steps for stable pediatric tachycardia patients with a narrow complex tachycardia?
Vagal maneuver
Adenosine: .1mg/kg max of 6 mg
Followed by: .2 mg/kg max of 12 mg
If unsuccessful but still stable:
 Amiodarone: 5 mg/kg over 20-60 minutes- max of 150 mg.
If unsuccessful but still stable, contact medical control. If unstable, proceed to cardioversion.
What are the steps for wide complex tachycardia and pediatric patients?
In unstable wide complex tachycardia obtain vascular access and then:
Synchronized cardioversion at .5–1 J/KG. Subsequent cardioversion is delivered at 2 J/KG.
If unable to synchronize then proceed with unsynchronized cardioversion.
In the case of torsades de pointes Cardiovert at 2 J/KG followed by 4 J/KG as indicated.
If stable:
Amiodarone at 5 mg/KG to a max of 150 mg over 20 to 60 minutes.
Or
Lidocaine at 1 mg/kg slow IV. Repeat ever 10 to 15 minutes to a max dose of 3 mg.
Magnesium Sulfate: first line agent for torsades de pointes: 25–50 mg per kilogram over 10 minutes.
Rapid administration can cause hypotension and respiratory depression.
What medication is contra indicated if the patient is suspected of a TCA overdose?
Amiodarone
What rate indicate probable sinus tachycardia?
180 beats per minute in children, and 220 bpm per minute infants
P waves present and regular
Variability of R – R
What indicates probable Supraventricular tachycardia?
Rates greater than 180 in children or 220 in infants.
P waves that are absent or abnormal
Regular R- R and the rate does not vary.
What indicates ventricular tachycardia?
Rates greater than 180 bpm and children and 220 bpm in infants.
Wide QRS complex
Regular heart rate
