Pediatric Tachycardia - Pulse & Poor Perfusion Algorithm

This algorithm provides a systematic approach for managing pediatric patients presenting with tachycardia and signs of poor perfusion, ensuring prompt and effective treatment to stabilize the child.

Initial Assessment and Stabilization

Identify and Treat Underlying Cause: Begin by assessing and addressing any 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 continuously assess heart rhythm, blood pressure, and oximetry.

Establish IV/IO Access: Secure intravenous or intraosseous access to facilitate the administration of medications.

12-Lead ECG: Obtain a 12-lead ECG if available to help in diagnosing the type of tachycardia. Therapy should not be delayed while waiting for this diagnostic tool.

Evaluate Rhythm and Initiate Treatment

Evaluate ORS Duration and Rhythm:

Narrow ORS (<0.09 sec): Likely indicates supraventricular tachycardia (SVT). Use history and ECG characteristics to differentiate probable sinus tachycardia from SVT.

Wide ORS (>0.09 sec): Suggests possible ventricular tachycardia (VT) and necessitates immediate intervention and expert consultation.

Pharmacological and Electrical Therapy

Adenosine Administration: If SVT is confirmed and the child is hemodynamically stable:

• First Dose: Administer 0.1 mg/kg as a rapid IV bolus (maximum of 6 mg).
• Second Dose: If the first dose is ineffective, administer 0.2 mg/kg as a rapid bolus (maximum of 12 mg).

Synchronized Cardioversion: If adenosine is ineffective or not feasible, or if VT is suspected:

• Initial Dose: Start with 0.5-1 J/kg. If ineffective, increase to 2 J/kg.
• Sedation: Sedate the child if possible to ensure comfort and safety during the procedure.

Further Management

Vagal Maneuvers: Consider performing vagal maneuvers in cases of SVT to attempt rhythm normalization.

Expert Consultation: Consult a pediatric cardiologist or electrophysiologist, especially in cases of suspected VT or ineffective initial treatments.

Administer Additional Medications as Needed:

• Amiodarone or Procainamide: May be considered for refractory tachycardia or confirmed VT, under expert guidance.

Monitor and Adjust Treatment

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

Adjust Treatments Based on Response and Expert Recommendations: Adapt the management plan according to the ongoing assessment and expert advice.