Pediatric Tachycardia, Ventricular Fibrillation or Pulseless Ventricular Tachycardia

Section 7 - PEDIATRIC / OBSTETRICAL

7.03 PEDIATRIC TACHYCARDIA, VENTRICULAR FIBRILLATION /PULSELESS VENTRICULAR TACHYCARDIA

Initial Medical Care including oxygen as needed

Attach monitor/defibrillator

STABLE: If adequate perfusion determine SVT, sinus tach or VT with a pulse.

Sinus Tachycardia

• Look for contributing factors.
• P-waves present / normal,
• Variable RR- constant PR
• Infants rate usually <220.
• Children rate usually <180
• Search for and treat cause.

Supraventricular Tachycardia

• P-waves absent / abnormal,
• HR not variable,
• History of abrupt rate changes.
• Infants rate usually >220
• Children rate usually >180.
• Consider vagal maneuvers No delays.

Refer to Handtevy System for medication administration

• ADENOSINE 0.1mg/kg IV / IO
• Repeat ADENOSINE 0.1mg/kg IV / IO x 1
• If still stable consult pediatric cardiologist. Transport to a Peds ER FL South or APH.
• If a cardiac Hx transport to the family’s hospital. It should be FL South or APH.**Prepare for cardioversion if the pt becomes unstable.

If the ORS is wide >0.08 sec. Probable ventricular tachycardia.
Refer to Handtevy System for medication administration

• Give Lidocaine 1mg/kg via IV bolus.
• Prepare for cardioversion if the pt becomes unstable.
• Treat the cause: Hypoxia; Hypovolemia; Hyperthermia; Hyper/hypokalemia Hypoglycemia; Tamponade (cardiac); Tension pneuomothorax; Toxins/poisons/drugs; Thromboembolism; Trauma

UNSTABLE:

• Poor Perfusion
  • Evaluate the QRS duration.

If narrow QRS less then <0.08 sec evaluate the ECG.

Supraventricular Tachycardia

• Synchronized cardioversion 0.5 to 1 J/kg
• Sedate if possible but do not delay.

If QRS is wide >0.08sec Possible Ventricular Tachycardia

• Treat with Synchronized carioversion 0.5 to 1 J/kg
• Sedate is possible but do not delay.
• May attempt Adenosine if it does not delay electrical cardioversion.
• Expert consultation advised.
• Treat the cause: Hypoxia; Hypovolemia; Hyperthermia; Hyper/hypokalemia Hypoglycemia; Tamponade (cardiac); Tension pneuomothorax; Toxins/poisons/drugs; Thromboembolism; Trauma

V-Fib or Pulseless V-Tach

• Initiate 5 cycles of high quality (30:2) one-rescuer or (15:2) two-rescuer CPR for approximately 2 minutes to allow blood to circulate and continue throughout resuscitation, minimizing interruptions.
• Maintain rate of between 100-120 compressions per minute.
• Maintain compression depth of at least 1/3 of the depth of the chest.
• Allow for complete chest recoil between compressions.
• Minimize interruptions
• Assist ventilations with OXYGEN @ 100% via BVM. DO NOT HYPERVENTILATE
• INTUBATE and establish peripheral IV or IO line as able.
• DEFIBRILLATION @ 2 J/kg.
  • Proceed to next step only if V-Fib / Pulseless V-Tach persists.
  • If rhythm converts, follow appropriate Practice Parameters.

Refer to Handtevy System for specific medication administration based on weight / length.

• EPINEPHRINE 1:10,000 (0.1mg/ml) 0.01 mg / kg IV /IO
• Repeat EPINEPHRINE 1:10,000 (0.1mg/ml) 0.01 mg / kg every 3 - 5 minutes of continued arrest.

• DEFIBRILLATION @ 4 J/kg. Continue CPR immediately.
• If rhythm converts, follow appropriate Practice Parameters.

• If hypovolemia suspected, fluid bolus 20 ml / kg.
• LIDOCAINE 1.0 mg/kg IV / IO.

• DEFIBRILLATION @ 6 J/kg. Continue CPR immediately.
• If rhythm converts, follow appropriate Practice Parameters

• After 10 minutes, LIDOCAINE 1.0 mg/kg IV / IO.
• DEFIBRILLATION @ 8 J/kg. Continue CPR immediately.
• If rhythm converts, follow appropriate Practice Parameter

If V-Fib converts to a pulse-producing tachycardic rhythm, follow with LIDOCAINE boluses IVP.