Pediatric Supraventricular Tachycardia History Signs and Symptoms Differential Past medical history Heart Rate: Child > 180/bpm Heart disease (Congenital) Medications or Toxic Ingestion Infant > 220/bpm Hypo / Hyperthermia (Aminophylline, Diet pills, Pale or Cyanosis Hypovolemia or Anemia Thyroid supplements, Diaphoresis Electrolyte imbalance Decongestants, Digoxin) Tachypnea Anxiety / Pain / Emotional stress Drugs (nicotine, cocaine) Vomiting Fever / Infection / Sepsis Congenital Heart Disease Hypotension Hypoxia Respiratory Distress Altered Level of Consciousness Hypoglycemia Syncope or Near Syncope Pulmonary Congestion Medication / Toxin / Drugs (see Syncope HX) Pulmonary embolus Trauma Tension Pneumothorax

Universal Patient Care Protocol Legend MR Continuous Cardiac Monitor B EMT B P Attempt to Identify Cause P I EMT- I I Narrow QRS duration < 0.08 s P EMT- P P P

Unstable or Pre-arrest M Medical Control M e Stable d

(No palpable BP, Altered mental status) i a t r i I IV Protocol I Synchronized Cardioversion c

P P

(0.5 joules/kg) a n

I Consider IV Protocol I d

May attempt O For sedation consider Valsalva's maneuver B

Diazepam or and / or Carotid P P P

P Massage initially and P Midazolam or r Lorazepam o after each drug t o

administration if If unsuccessful c

indicated. P Repeat Cardioversion P o l (1.0 - 2.0 joules/kg) s

Adenosine P P May Repeat X 1 If rhythm changes Go to Appropriate Protocol

Notify Destination or M M Contact Medical Control

Pearls Recommended Exam: Mental Status, Skin, Neck, Lung, Heart, Abdomen, Back, Extremities, Neuro Carefully evaluate the rhythm to distinguish Sinus Tachycardia, Supraventricular Tachycardia, and Ventricular Tachycardia Separating the child from the caregiver may worsen the child's clinical condition. Pediatric paddles should be used in children < 10 kg or Broselow-Luten color Purple Monitor for respiratory depression and hypotension associated if Diazepam or Midazolam is used. Continuous pulse oximetry is required for all SVT Patients if available. Document all rhythm changes with monitor strips and obtain monitor strips with each therapeutic intervention. As a rule of thumb, the maximum sinus tachycardia rate is 220 – the patient’s age in years. Protocol 48 Any local EMS System changes to this document must follow the NC OEMS Protocol Change Policy and be approved by OEMS 2009