Initial Management of Pediatric Tachycardia

Immediate Stabilization and Assessment

The American Heart Association recommends maintaining a patent airway and assisting breathing as necessary in pediatric patients with tachycardia 1, 2
Administer supplemental oxygen to address hypoxemia, which commonly drives tachycardia, as recommended by the American College of Cardiology 1, 3
Attach cardiac monitor/defibrillator to identify the rhythm, as suggested by the American Heart Association 1, 2
Monitor blood pressure and pulse oximetry continuously, as recommended by the American College of Cardiology 1, 2
Establish IV or IO access as soon as possible, as suggested by the American Heart Association 1, 2
Obtain a 12-lead ECG if available, but do not delay therapy, as recommended by the American College of Cardiology 1, 2, 3

For unstable patients, the American Heart Association recommends proceeding immediately to synchronized cardioversion 1, 3
Use sedation if the patient is conscious and time permits, as suggested by the American College of Cardiology 4, 5, 3
Start with 0.5 to 1 J/kg; if unsuccessful, increase to 2 J/kg, as recommended by the American Heart Association 4, 5

For narrow-complex tachycardia, the American College of Cardiology recommends differentiating sinus tachycardia from supraventricular tachycardia (SVT) using the 12-lead ECG and clinical history 1, 2, 6
Attempt vagal maneuvers first (Class IIa recommendation), unless the patient is hemodynamically unstable or this will delay definitive treatment, as suggested by the American Heart Association 1, 2, 6, 4, 5, 7
If vagal maneuvers fail and IV/IO access is available, adenosine is the drug of choice (Class I recommendation), as recommended by the American College of Cardiology 1, 2, 6
Initial dose: 0.1 mg/kg rapid IV/IO bolus (maximum first dose 6 mg), as suggested by the American Heart Association 1, 2, 5
Second dose: 0.2 mg/kg rapid bolus (maximum second dose 12 mg), as recommended by the American College of Cardiology 1, 2
Consider synchronized cardioversion (0.5 to 1 J/kg, increasing to 2 J/kg if needed) if adenosine fails or SVT recurs, as suggested by the American Heart Association 4, 5
For refractory cases, consider amiodarone 5 mg/kg IV/IO over 20-60 minutes OR procainamide 15 mg/kg IV/IO over 30-60 minutes, as recommended by the American College of Cardiology 1, 2, 4, 5

Underlying causes to identify and treat: dehydration, fever, pain, anxiety, hypoxemia, anemia, and drug toxicity can all cause or contribute to tachycardia, as suggested by the American Heart Association 1, 2, 7
Monitor continuously during treatment to evaluate the effect of interventions, as recommended by the American College of Cardiology 1, 2
Consultation with an expert in pediatric arrhythmias is strongly recommended before treating hemodynamically stable children, as suggested by the American Heart Association 1, 2