Pediatric Advance Life Support: SVT Part 5

Adenosine

·         Drug of choice for treatment of SVT

·         Blocks conduction through the AV node

·         Continuous ECG monitor

·         Give 0.1mg/kg- max initial dose 6mg

·         Very short half life

·         Use rapid flush technique

·         May double dose if ineffective

Note: If vascular access is immediately available, rapidly administer 0.1 mg/kg adenosine via IV or IO, immediately followed by a rapid flush of at least 5 mL saline.

If there is no response, repeat the dose at 0.2 mg/kg to a maximum individual dose of 12 mg, using the same technique.

In any patient who exhibits SVT, obtain recordings of the cardiac rhythm before, during, and after interventions.

Note:  Side effects with adenosine are common but transient; flushing, dyspnea, and chest discomfort are the most frequently observed.  Adenosine should not be given to patients with asthma.

Technique for Adenosine Administration

·         Draw up adenosine

·         Prepare NS flush

·         Continuous ECG

·         Apply 3-way stop cock to IV site

·         Place adenosine on one end of the stop cock and NS on the other end

·         Push adenosine as rapidly as possible

·         Rapidly flush with NS immediately

Pause after Adenosine

Verapamil

0.1 to 0.3 mg/kg is also effective in terminating SVT in older children

Should not be used in infants without expert consultation

Refractory SVT

Amiodarone 5 mg/kg IO/IV over 20 to 60 minutes

Procainamide 15 mg/kg IO over 30 to 60 minutes

Seek expert consultation when giving amiodarone or procainamide

Do not routinely administer amiodarone and procainamide together

Antiarrhymics

Expert consultation is strongly recommended prior to administration

If there is no effect and there are no signs of toxicity, give additional doses

Avoid simultaneous use of amiodarone and procainamide without expert consultation