Pediatric Advance Life Support: SVT Part 2

Mnemonic for Treating SVT

·         Primary Survey

·         Recognize symptoms of instability

·         Evaluate rhythm- EKG

·         Vagal Maneuvers

·         Adenosine

·         Intervene electrically

·         Look to the Experts

Primary Survey

·         Airway- supplemental oxygen

·         Breathing

·         Circulation

·         Check VS

·         Assess pulse

·         Attach defibrillator/monitor

·         12 lead EKG

·         IV access

Note

Because hypoxemia is a common cause of tachycardia, initial evaluation of any patient with tachycardia should focus on signs of increased work of breathing (tachypnea, intercostal retractions, suprasternal retractions, paradoxical abdominal breathing) and oxyhemoglobin saturation as determined by pulse oximetry

Recognize Symptom of Instability

·         Evaluate the patient: symptomatic or unstable

·         Identify potential reversible causes of the tachycardia

Note:

Many experts suggest that when a heart rate is <180/minute (children) or < 220/min (infants), it is unlikely that symptoms of instability are caused primarily by the tachycardia unless there is impaired ventricular function.

Symptomatic Tachycardia

·         Symptomatic implies that an arrhythmia is causing symptoms, such as palpitations, lightheadedness, or dyspnea, but the patient is stable and not in imminent danger.

·         In such cases more time is available to decide on the most appropriate intervention

Unstable Tachycardia

·         Refers to a condition in which vital organ function is acutely impaired or cardiac arrest is ongoing or imminent.

·         When an arrhythmia causes a patient to be unstable, immediate intervention is indicated

Symptoms of Instability

·         Chest pain

·         Syncope

·         Shortness of breath

·         Cold and clammy skin

·         Decreased level of consciousness

·         Hypotension

·         Pulmonary congestion