Paediatrics: Treating supraventricular tachycardia

2021-03-10 12:00 AM

Algorithm for treating a patient with supraventricular tachycardia, but not in shock

reating supraventricular tachycardia

Attach a cardiac monitor and check BP.

Algorithm for treating a patient with supraventricular tachycardia, but not in shock

1 Trial of vagal manoeuvres

2 Adenosine

  • 50–100microgram/kg given as a rapid IV push into the most central IV access available followed by fast IV flush
  • If no response, then 100–200microgram/kg
  • If no response, then increase at increments of 50–100microgram/kg to a maximum single dose of 500microgram/kg

3 Consider

  • Synchronous DC shock
  • Amiodarone (IV bolus over 10min) 5mg/kg
  • Procainamide (IV loading dose of 15mg/kg over 30–60min). Stop infusion if QRS widens or hypotension occurs
  • Flecainide (IV 2mg/kg bolus over 20min)
  • Seek advice

Algorithm for treating the patient with SVT who is in shock

1a Attempt vagal manoeuvres but do not delay progress to step 2

1b If IV access is available give adenosine (see preceding algorithm) but do not delay progress to step 2

2 Synchronous DC shock

  • 1J/kg
  • If no response, then 2J/kg
  • If no response, then 2J/kg

3 Consider using antiarrhythmics (amiodarone)

4 Synchronous DC shock

  • Return to step 2 in the algorithm at 2J/kg