4-11 PEDIATRIC TACHYCARDIA

From CRS EMS Guidelines
EMR - Emergency Medical Responder
  1. Establish patient responsiveness. If cervical spine trauma is suspected, manually stabilize the spine.
  2. Assess the patient’s airway of patency, protective reflexes and the possible need for advanced airway management. Look for signs of airway obstruction and if present proceed as per airway obstruction protocol.
  3. Open the airway via chin lift or modified jaw thrust.
  4. Suction as necessary
  5. Consider placing an oropharyngeal or nasopharyngeal airway adjunct if the airway cannot be maintained with positioning and the patient is unconscious.
  6. Assess patient breathing, including mental status, rate, auscultation, inspection, respiratory effort, adequacy of ventilation as indicated by chest rise and obtain a pulse oximetry reading.
  7. If signs of respiratory arrest or respiratory failure with inadequate breathing are present, assist ventilation using a B-V-M device with 100% oxygen.
  8. If breathing is adequate, place the child in a position of comfort and administer high-flow 100% oxygen as tolerated.
  9. Assess circulation and perfusion.
  10. Call for ALS intercept
EMT - Emergency Medical Technician  Perform/Confirm All Above Interventions
  1. Assess patient breathing, including mental status, rate, auscultation, inspection, respiratory effort, adequacy of ventilation as indicated by chest rise and obtain a pulse oximetry reading.
  2. Check blood glucose and if less than 60 mg/dL, refer to pediatric hypoglycemia protocol.
  3. Initiate rapid transport and Contact MEDICAL CONTROL to request ALS intercept.
AEMT – Advanced Emergency Medicine Tech   Perform/Confirm All Above Interventions
  1. Assess patient breathing, including rate, auscultation, inspection, respiratory effort, adequacy of ventilation as indicated by chest rise and obtain a pulse oximetry reading.
  2. Evaluate for endotracheal intubation if trained to do so.
  3. Establish vascular access and administer NS at a TKO rate. If IV access unlikely or cannot be obtained in 2 attempts in a child less than 6 and the patient has findings of poor perfusion, consider IO access.
  4. Contact MEDICAL CONTROL to request ALS intercept and for orders regarding rate of fluid administration.
  5. Initiate cardiac monitoring
Intermediate - Perform/Confirm All Above Interventions
  1. If no pulses present, treat per pediatric cardiac arrest protocol.
  2. If Wide Complex tachycardia with a pulse but poor perfusion:
    1. Contact MEDICAL CONTROL for consideration of the following therapies:
      1. Synchronized cardioversion
        1. Consider need for sedation balanced with need for cardioversion and obtain paramedic intercept if not critical.
        2. Perform synchronized cardioversion at 1 J/kg. If the patient remains in Wide Complex tachycardia with a pulse, repeat cardioversion at 2 J/kg.
      2. If unsuccessful lidocaine 1mg/kg IV/IO bolus. (Alternate administer amiodarone (Cordarone) 5mg/kg IV/IO over 20 to 60 minutes may be ordered by medical control).
    2. Initiate transport
  3. If Wide Complex tachycardia and adequate perfusion
    1. Contact MEDICAL CONTROL for consideration of the following therapies:
    2. Administer lidocaine 1mg/kg IV/IO bolus. (Alternate: administer amiodarone (Cordarone) 5mg/kg IV/IO over 20 to 60 minutes may be ordered by medical control).
    3. If symptoms persist, consider synchronized cardioversion:
      1. Consider need for sedation balanced with need for cardioversion and obtain paramedic intercept if not critical.
      2. Perform synchronized cardioversion at 1 J/kg. If the patient remains in Wide Complex tachycardia with a pulse, repeat cardioversion at 2 J/kg.
    4. Initiate Transport
  4. If Narrow complex and sinus tachycardia suspected treat underlying causes.
    1. Administer high-flow 100% oxygen as tolerated.
    2. Administer 20 mL/kg bolus of NS bolus.
    3. Initiate transport
  5. Narrow Complex with pulse and poor perfusion:
    1. Consider administration of 20 mL/kg bolus of NS if suspicion of dehydration or sinus tachycardia.
    2. Contact MEDICAL CONTROL for consideration of the following therapies:
      1. Administer adenosine (Adenocard) 0.1 mg/kg rapid IV/IO bolus (max dose 6 mg). May be repeated at 0.2 mg/kg (max dose 12 mg) if unsuccessful.
      2. If symptoms persist, consider synchronized cardioversion:
        1. Consider need for sedation balanced with need for cardioversion and obtain paramedic intercept if not critical.
        2. Perform synchronized cardioversion at 1 J/kg. If the patient remains in Wide Complex tachycardia with a pulse, repeat cardioversion at 2 J/kg.
      3. If symptoms persist, consider administration of amiodarone (Cordarone) 5/mg/kg over 20 to 60 minutes.
    3. Initiate transport
Paramedic - Perform/Confirm All Above Interventions
  1. If no pulses present, treat per pediatric cardiac arrest protocol.
  2. If Wide Complex tachycardia with a pulse but poor perfusion:
    1. Proceed with the following therapy:
      1. Synchronized cardioversion
        1. Consider sedation via administration of midazolam (Versed) 0.1 mg/kg IV or IO (Max dose 2 mg)
        2. Perform synchronized cardioversion at 1 J/kg. If the patient remains in Wide Complex tachycardia with a pulse, repeat cardioversion at 2 J/kg.
      2. If unsuccessful lidocaine 1mg/kg IV/IO bolus. (Alternate administer amiodarone (Cordarone) 5mg/kg IV/IO over 20 to 60 minutes may be ordered by medical control).
    2. Contact MEDICAL CONTROL
    3. Initiate transport
  3. If Wide Complex tachycardia and adequate perfusion
    1. Contact MEDICAL CONTROL for consideration of the following therapies:
      1. Administer lidocaine 1mg/kg IV/IO bolus. (Alternate: administer amiodarone (Cordarone) 5mg/kg IV/IO over 20 to 60 minutes may be ordered by medical control).
      2. If symptoms persist, consider synchronized cardioversion:
        1. Consider sedation via administration of midazolam (Versed) 0.1 mg/kg IV/IO (Max dose 2 mg)
        2. Perform synchronized cardioversion at 1 J/kg. If the patient remains in Wide Complex tachycardia with a pulse, repeat cardioversion at 2 J/kg.
    2. Initiate Transport
  4. If Narrow complex and sinus tachycardia suspected treat underlying causes.
    1. Administer high-flow 100% oxygen as tolerated.
    2. Administer 20 mL/kg bolus of NS bolus.
    3. Initiate transport
  5. Narrow Complex with pulse and poor perfusion:
    1. Consider administration of 20 mL/kg bolus of NS if suspicion of dehydration or sinus tachycardia.
    2. Contact MEDICAL CONTROL for consideration of the following therapies:
      1. Administer adenosine (Adenocard) 0.1 mg/kg rapid IV/IO bolus (max dose 6 mg). May be repeated at 0.2 mg/kg (max dose 12 mg) if unsuccessful.
      2. If symptoms persist, consider synchronized cardioversion:
        1. Consider sedation via administration of midazolam (Versed) 0.1 mg/kg IV/IO (Max dose 2 mg)
        2. Perform synchronized cardioversion at 1 J/kg. If the patient remains in Wide Complex tachycardia with a pulse, repeat cardioversion at 2 J/kg.
      3. If symptoms persist, consider administration of amiodarone (Cordarone) 5/mg/kg over 20 to 60 minutes.
    3. Initiate transport
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