Algorithm for Pediatric Tachycardia with Pulse and Poor Perfusion - Flowchart
Algorithm for Pediatric Tachycardia with Pulse and Poor Perfusion - Flowchart Pediatric Resuscitation Pediatric Resuscitation
«Flowchart»

Pediatric tachycardia with pulse and poor perfusion

Pediatric tachycardia with pulse and poor perfusion

Pediatric tachycardia with pulse and poor perfusion

O2/respiratory assistance

O2/respiratory assistance

O2/respiratory assistance

2

QRS morphology

QRS morphology

QRS morphology

Narrow (≤0.09 sec)

Narrow (≤0.09 sec)

≤ Narrow (≤0.09 sec) ≤

Wide (>0.09 sec) [Possible VT]

Wide (>0.09 sec) [Possible VT]

Wide (>0.09 sec) [Possible VT]

Sinus tachycardia

Sinus tachycardia

Sinus tachycardia

Infant HR <220/min
Child HR <180/min
P waves normal
P-R constant
R-Rvariable

Infant HR <220/min
Child HR <180/min
P waves normal
P-R constant
R-Rvariable





Infant HR <220/min

Infant HR ≥220/min
Child HR ≥180/min
P waves absent/abnormal
HR not variable
Abrupt rate change

Infant HR ≥220/min
Child HR ≥180/min
P waves absent/abnormal
HR not variable
Abrupt rate change

≥
≥


Infant HR ≥220/min ≥

Identify/Treat cause

Identify/Treat cause

Identify/Treat cause

End

End

End

Adenosine (0.1 mg/kg up to 6 mg; 0.2 mg/kg up to 12 mg for 2nd dose)

Adenosine (0.1 mg/kg up to 6 mg; 0.2 mg/kg up to 12 mg for 2nd dose)

Adenosine (0.1 mg/kg up to 6 mg; 0.2 mg/kg up to 12 mg for 2nd dose)

refractory SVT

refractory SVT

refractory SVT

Synchronized cardio version

Synchronized cardio version

Synchronized cardio version

Hypotension
Altered mental status
Shock

Hypotension
Altered mental status
Shock

Hypotension
Altered mental status
Shock



Symptomatic

Symptomatic

Symptomatic

Asymptomatic

Asymptomatic

Asymptomatic

Synchronized Cardioversiona (0.5-1 J/kg)

Synchronized Cardioversiona (0.5-1 J/kg)

Synchronized Cardioversiona (0.5-1 J/kg)

a a

Consider adenosine

Consider adenosine

Consider adenosine

Regular, monomorphic rhythm

Regular, monomorphic rhythm

Regular, monomorphic rhythm

Amiodaroneb (5 mg/kg over 20-60 min)

Amiodaroneb (5 mg/kg over 20-60 min)

b Amiodarone

Amiodaroneb (5 mg/kg over 20-60 min)

Amiodaroneb (5 mg/kg over 20-60 min)

Amiodaroneb (5 mg/kg over 20-60 min)

b b

aIf not effective, increase to 2 J/kg.

aIf not effective, increase to 2 J/kg.

aIf not effective, increase to 2 J/kg.

a

bAlternative to amiodarone is procainamide, 15 mg/kg over 30 to 60 minutes, but should not be given together and given with caution as can precipitate torsades.

bAlternative to amiodarone is procainamide, 15 mg/kg over 30 to 60 minutes, but should not be given together and given with caution as can precipitate torsades.

bAlternative to amiodarone is procainamide, 15 mg/kg over 30 to 60 minutes, but should not be given together and given with caution as can precipitate torsades.

b

cVagal stimulation should be attempted unless hemodynamically unstable or if it would delay medical or electrical cardioversion. Can be performed with ice applied to the face of infants/young children or carotid massage/Valsalva in older children.

cVagal stimulation should be attempted unless hemodynamically unstable or if it would delay medical or electrical cardioversion. Can be performed with ice applied to the face of infants/young children or carotid massage/Valsalva in older children.

cVagal stimulation should be attempted unless hemodynamically unstable or if it would delay medical or electrical cardioversion. Can be performed with ice applied to the face of infants/young children or carotid massage/Valsalva in older children.

c

SVT

SVT

SVT

Vagal maneuverc

Vagal maneuverc

c c Vagal maneuver

Adenosine (0.1 mg/kg up to 6 mg; 0.2 mg/kg up to 12 mg for 2nd dose)

Adenosine (0.1 mg/kg up to 6 mg; 0.2 mg/kg up to 12 mg for 2nd dose)

Adenosine

Pediatric tachycardia with pulse and poor perfusion

O2/respiratory assistance

QRS morphology

Narrow (≤0.09 sec)

Narrow (≤0.09 sec)

Wide (>0.09 sec) [Possible VT]

Wide (>0.09 sec) [Possible VT]

1==>5

5==>6