Pediatric Tachycardia/Unstable
(Mental Status Changes, No Palpable Radial Pulse)
Narrow Complex
≤0.11 Sec
General Pediatric Assessment
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Cardiac monitor
Vascular Access
Continue Assessment
Go to Vascular Access
Wide Complex
≥0.12 Sec
Torsades de
Points
Monomorphic
VT
☎
If IV established
administer
ADENOSINE
0.2 mg/kg rapid IVP
not to exceed 12 mg
Rhythm change?
No
Defibrillate at 2 J/kg
increasing to 4 J/kg;
Consider sedation:
ETOMIDATE
0.15 mg/kg IV
Rhythm change?
No
Synchonized
Cardioversion
Start at 0.5 to 1 J/kg;
may use 2 J/kg
if unsuccessful;
or defibrilate at 2 J/kg
increasing to 4 J/kg;
Consider sedation:
ETOMIDATE
0.15 mg/kg IV
Rhythm change?
No
AMIODARONE
5.0 mg/kg
in 50 cc NS
over 10 min
☎
Synchonized
Cardioversion
Start at 0.5 to 1 J/kg;
may use 2 J/kg
if unsuccessful;
or defibrilate at 2 J/kg
increasing to 4 J/kg;
Consider sedation:
ETOMIDATE
0.15 mg/kg IV
Yes
Yes
Rhythm change?
Yes
☎
MAGNESIUM
SULFATE
25 mg/kg IV
in 50 cc NS
over 10 min
Rhythm change?
Yes
Rhythm change?
No
No
No
Yes
Repeat Synchonized
Cardioversion
or Defibrillate
if VT not resolved;
Assess need
for repeat sedation;
repeat
AMIODARONE
Rhythm change?
No
Yes
Transport
Transport
Transport
Continue General Pediatric Assessment
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