Pediatric Tachycardia With A Pulse and Adequate Perfusion Algorithm

This algorithm addresses the management of pediatric patients who present with tachycardia accompanied by a pulse and adequate perfusion, guiding the clinician through diagnosis and appropriate interventions.

Initial Assessment and Support

Identify and Treat Underlying Cause: Start by identifying potential underlying causes of tachycardia.

Maintain Patent Airway: Ensure the child's airway is clear and assist breathing as necessary.

Administer Oxygen and Monitor: Provide supplemental oxygen and place the child on a cardiac monitor to assess heart rhythm, blood pressure, and oximetry continuously.

Obtain 12-Lead ECG: Acquire a 12-lead ECG if available to aid in diagnosing the type of tachycardia, ensuring that treatment is not delayed in its absence.

Evaluate Rhythm and ORS Duration

Evaluate ORS Duration:

Normal ORS (≤ 0.09 sec): Indicates probable sinus tachycardia or supraventricular tachycardia (SVT).

Wide ORS (≥ 0.09 sec): Suggests possible ventricular tachycardia or SVT with aberrancy.

Specific Rhythmic Assessments and Actions

Probable Sinus Tachycardia:

• Confirm with historical compatibility, presence of P waves, and variable R-R intervals with a constant PR interval.
• Search for and treat the underlying cause.

Probable Supraventricular Tachycardia:

• Establish vascular access.
• Consider administering adenosine: 0.1 mg/kg IV for the first dose (max 6 mg), followed by 0.2 mg/kg IV for the second dose (max 12 mg), using a rapid bolus technique.
• Consider vagal maneuvers to attempt normalization of heart rate.

Probable Ventricular Tachycardia:

• Expert consultation is strongly recommended.
• Consider pharmacologic conversion with amiodarone (5 mg/kg IV over 20-60 minutes) or procainamide (15 mg/kg IV over 30-60 minutes).
• Do not administer amiodarone and procainamide together routinely.
• If uncertain, may attempt adenosine if not already administered.
• Consider electrical cardioversion: start with 0.5-1 J/kg, increasing to 2 J/kg if ineffective, after sedation.

Ongoing Management and Monitoring

Continuous Monitoring: Keep monitoring the child’s heart rhythm, vital signs, and response to treatment.

Adjust Treatments Based on Evaluation and Expert Advice: Modify the management plan according to the ongoing assessment, expert consultation, and the child’s response to initial interventions.