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Supraventricular Tachycardia: Birmingham Children's Hospital ED Handbook Version 1 (2011)

This document provides guidelines for identifying and treating supraventricular tachycardia (SVT) in children. It describes characteristics of SVT such as a heart rate over 180 bpm in older children or 220 bpm in infants. SVT is identified by negative P waves on an electrocardiogram. The document recommends using vagal maneuvers like cold water or pressure on the carotid sinus as first treatments, and if those fail, administering adenosine in increasing doses up to 300 mcg/kg intravenously with saline flush. If adenosine is not effective, synchronous direct current shock may be used starting at 1 J/kg and increasing to 2 J/kg if needed. Amiodarone or

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144 views1 page

Supraventricular Tachycardia: Birmingham Children's Hospital ED Handbook Version 1 (2011)

This document provides guidelines for identifying and treating supraventricular tachycardia (SVT) in children. It describes characteristics of SVT such as a heart rate over 180 bpm in older children or 220 bpm in infants. SVT is identified by negative P waves on an electrocardiogram. The document recommends using vagal maneuvers like cold water or pressure on the carotid sinus as first treatments, and if those fail, administering adenosine in increasing doses up to 300 mcg/kg intravenously with saline flush. If adenosine is not effective, synchronous direct current shock may be used starting at 1 J/kg and increasing to 2 J/kg if needed. Amiodarone or

Uploaded by

madimadi11
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Birmingham Children’s Hospital ED Handbook Version 1 (2011)

(1.6) SUPRAVENTRICULAR TACHYCARDIA

Characteristics of SVT (as compared with sinus tachycardia) Vagal manoeuvres


220 bpm in infants (> 180 bpm in older children). Diving reflex (face immersed in
Negative P waves in II, III, aVF. iced water for 5 secs or ice in
glove applied to face)
No beat-to-beat variability.
1-sided carotid sinus manage
Abrupt termination.
Valsalva manoeuvre (e.g. blowing
Less likely to have a history consistent with shock. plunger out of a 50 ml syringe)

MANAGEMENT OF SUPRAVENTRICULAR TACHYCARDIA (SVT)

YES Shock NO
present?

Vagal manoeuvre
Vagal manoeuvre
If no delays

Vascular YES Adenosine 100 mcg/kg


access quicker
than setting up with rapid saline flush
defibrillator?
2 mins

NO
Adenosine 200 mcg/kg
with rapid saline flush
Synchronous DC
shock 1 J/kg
2 mins

Adenosine 300 mcg/kg


with rapid saline flush

Synchronous DC
shock 2 J/kg

Consider:
Adenosine 400 – 500 mcg/kg
Max dose 12 mg
Consider
Neonates: max 300 mcg/kg
amiodarone
Synchronous DC shock
Amiodarone or other antiarrhythmic
(discuss with cardiology)

Reference
APLS The Practical Approach (5th Edition)

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