Tachyarrhythmia

1. Identify and treat underlying cause

• • Maintain patent airway; assist breathing as necessary • Oxygen • Cardiac monitor to identify rhythm; monitor blood pressure and oximetry • IO/IV access • 12-Lead ECG if available; don't delay therapy

2. Evaluate QRS duration

• • Narrow (≤0.09 sec) → Evaluate rhythm with 12-lead ECG or monitor
• • Wide (>0.09 sec) → Possible Ventricular Tachycardia

Narrow QRS — Evaluate rhythm

• 4. Probable Sinus Tachycardia: • Compatible history consistent with known cause • P waves present/normal • Variable R-R; constant PR • Infants: rate usually <220/min • Children: rate usually <180/min → 6. Search for and treat cause
• 5. Probable Supraventricular Tachycardia: • Compatible history (vague, nonspecific); history of abrupt rate changes • P waves absent/abnormal • HR not variable • Infants: rate usually ≥220/min • Children: rate usually ≥180/min → 7. Consider vagal maneuvers (No delays) → 8. If IO/IV access present, give adenosine OR if IO/IV access not available, or if adenosine ineffective, synchronized cardioversion

Wide QRS — Possible Ventricular Tachycardia

• 10. Cardiopulmonary compromise? • Hypotension • Acutely altered mental status • Signs of shock
• Yes → 11. Synchronized cardioversion
• No → 12. Consider adenosine if rhythm regular and QRS monomorphic → 13. Expert consultation advised: • Amiodarone • Procainamide

Doses/Details

• Synchronized Cardioversion: Begin with 0.5-1 J/kg; if not effective increase to 2 J/kg. Sedate if needed, but don't delay cardioversion.
• Adenosine IO/IV Dose: First dose: 0.1 mg/kg rapid bolus (maximum: 6 mg). Second dose: 0.2 mg/kg rapid bolus (maximum second dose 12 mg).
• Amiodarone IO/IV Dose: 5 mg/kg over 20-60 minutes or Procainamide IO/IV Dose: 15 mg/kg over 30-60 minutes Do not routinely administer amiodarone and procainamide together