Ventricular Tachycardia Management in the Child

Aka: Ventricular Tachycardia Management in the Child

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II. Indications: Wide Complex Tachycardia in Children

  1. Tachycardia AND
  2. Wide QRS Complex (duration > 0.08 sec)
    1. Note adult wide complex is defined as (at least 0.12 sec)

III. Approach

  1. No pulse
    1. Treat as Pulseless Ventricular Tachycardia
  2. Unstable (shock or ALOC)
    1. Treat as Unstable Ventricular Tachycardia
    2. Administer Synchronized Cardioversion
  3. Stable
    1. Treat per protocol below

IV. Protocol: Stable Wide Complex Tachycardia (presumed Ventricular Tachycardia) Management

  1. Electrical Cardioversion if unstable or refractory to below measures
    1. Sedation and analgesia if no delay
    2. Synchronized Cardioversion Dose
      1. First: 0.5-1.0 Joules/kg
      2. Next: 2.0 Joules/kg
  2. Step 1: Adenosine
    1. AVOID if polymorphic or irregular Wide Complex Tachycardia (can degenerate to VF)
    2. Dose
      1. First: 0.1 mg/kg (max 6 mg) rapid IV push
      2. Next: 0.2 mg/kg (max 12 mg) rapid IV push
    3. Effect
      1. SVT: converts or at least slows rhythm for interpretation
      2. VT: no effect (unless irregular, in which case could degenerate into VF)
  3. Step 2: Choose one Antiarrhythmic (do not use both)
    1. Consultation with pediatric cardiology recommended
    2. Amiodarone 5 mg/kg (max 150 mg) IV over 20 to 60 minutes OR
    3. Procainamide 15 mg/kg IV over 30 to 60 minutes

V. References

  1. Pediatric Resucitation
    1. http://pediatrics.aappublications.org/content/126/5/e1361.full.html
    2. (2010) Pediatrics 126(5): e1361 [PubMed]

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