Follow General Pediatric Protocol.
Mandatory interventions:
a. Oxygen
b. IV access
c. Cardiac monitoring
d. 12-lead EKG
Tachycardia in children is most commonly sinus in origin and is most commonly the result of a primary respiratory disturbance.
BRADYCARDIA
Treat on if symptomatic with altered mental status, significant hypotension, or secondary to drug overdose.
Administer EPINEPHRINE 1:10,000 0.01 mg/kg (0.1 mL/kg) IV every 3 – 5 minutes as needed.
If AV block apparent, administer ATROPINE 0.02 mg/kg IV (minimum dose 0.1 mg).
SUPRAVENTRICULAR TACHYCARDIA
May attempt vagal maneuver(s) if child able to cooperate:
a. Valsalva maneuver
b. Ice water facial immersion (only for infants)
Contact Medical Control:
a. ADENOSINE (Adenocard) 0.1 mg/kg rapid IV (maximum dose 6 mg) followed by 5 – 10 mL saline flush; if response is transient or absent, after 1 minute may repeat ADENOSINE (Adenocard) 0.2 mg/kg rapid IV (maximum dose 12 mg) followed by 5 – 10 mL saline flush.
b. If the child is unstable with the following signs AND a HR > 220, anticipate orders for synchronized cardioversion at 0.5 – 1.0 J/kg. Child should be sedated with MIDAZOLAM (Versed) 0.2 mg/kg IV prior to cardioversion.
i. Decreased level of consciousness, weak and thready pulses, or no palpable blood pressure.