Paediatrics: Treating supraventricular tachycardia

Treating supraventricular tachycardia

Attach cardiac monitor and check BP.

Algorithm for treating 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 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 anti-arrhythmics (amiodarone)

4 Synchronous DC shock

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