PEDIATRIC TACHYCARDIA WITH POOR PERFUSION
See also RED 9-NARROW-COMPLEX TACHYCARDIA (SVT)
FIRST RESPONDER / EMT-BASIC
1. Open airway. Consider airway adjunct, if airway not maintainable by head
positioning or a towel under the shoulders
2. High flow O2, assist ventilation with bag-mask ventilation and suction as
necessary
3. Keep child warm and dry
4. Request ALS if available
EMT-BASIC
5. Pulse oximeter
PARAMEDIC
6. Advanced airway as indicated
7. Cardiac monitor / IV as indicated
8. Stable patient, no serious signs or symptoms
a. Transport
b. Vagal maneuvers
c. Twelve-lead EKG (ORANGE 5)
9. Unstable patient, serious signs and symptoms. Establish heart rate as cause of
serious signs and symptoms
d. Twelve-lead EKG (ORANGE 5)
e. Evaluate QRS duration
QRS DURATION NORMAL FOR AGE: ≤0.08
QRS DURATION WIDE FOR AGE: >0.08
Probable ST
Probable SVT
Probable VT
 Hx compatible with
 Hx incompatible 10. Immediate cardioversion 1 J/kg
sinus tach
with sinus tach
11. Sedation if possible: diazepam 0.1-0.2
 P waves present
 P wave absent
mg/kg IV/IO (max. 4mg), 0.5 mg/kg PR
 HR varies with
 HR not variable
(max. 10 mg), but do not delay
activity/resp
with activity/resp
cardioversion.
 Variable RR with
 Abrupt rate
12. If no change, repeat cardioversion as
constant pr
changes
necessary at 2 J/kg
 Infants: <220 bpm
 Infants: >220
13. Lidocaine 1mg/kg IV bolus
 Children: <180 bpm
bpm
 Children >180
bpm
10. Consider vagal
maneuvers (no
delay)
11. Cardioversion 1 J/kg. Sedation if possible:
diazepam 0.1-0.2 mg/kg IV/IO (max. 4mg),
0.5 mg/kg PR (max. 10mg), but do not
delay cardioversion
11. Or Adenosine: if IV/IO access immediately
available 0.1 mg/kg (max first dose 6mg)
followed by 5cc saline bolus
May double dose and repeat twice (maximum
dose 12 mg)
PINK 9