II. Indications: Wide Complex Tachycardia in Children
- Tachycardia AND
- Wide QRS Complex (duration > 0.08 sec)
- Note adult wide complex is defined as (at least 0.12 sec)
III. Approach
- No pulse
- Treat as Pulseless Ventricular Tachycardia
- Unstable (shock or ALOC)
- Treat as Unstable Ventricular Tachycardia
- Administer Synchronized Cardioversion
- Stable
- Treat per protocol below
IV. Protocol: Stable Wide Complex Tachycardia (presumed Ventricular Tachycardia) Management
- Electrical Cardioversion if unstable or refractory to below measures
- Sedation and analgesia if no delay
- Synchronized Cardioversion Dose
- First: 0.5-1.0 Joules/kg
- Next: 2.0 Joules/kg
- Step 1: Adenosine
- AVOID if polymorphic or irregular Wide Complex Tachycardia (can degenerate to VF)
- Dose
- First: 0.1 mg/kg (max 6 mg) rapid IV push
- Next: 0.2 mg/kg (max 12 mg) rapid IV push
- Effect
- SVT: converts or at least slows rhythm for interpretation
- VT: no effect (unless irregular, in which case could degenerate into VF)
- Step 2: Choose one Antiarrhythmic (do not use both)
- Consultation with pediatric cardiology recommended
- Amiodarone 5 mg/kg (max 150 mg) IV over 20 to 60 minutes OR
- Procainamide 15 mg/kg IV over 30 to 60 minutes