Pediatric Advance Life Support: SVT Part 6

Intervene Electrically: Synchronized Cardioversion

·         Specific timed delivery of electrical shock to the heart

·         Treatment of choice for SVT, VT with a pulse and atrial flutter with evidence of poor profusion

·         Initial energy level is 0.5-1J/kg

·         May be increased to 1-2J/kg on second attempt

·         Provide sedation and analgesia

Note:  In synchronized cardioversion, energy delivery is synchronized (occurs simultaneous with the QRS) with the ECG so that impulses are not delivered during the ventricle’s relative refractory period, as this could cause ventricular fibrillation. Synchronized cardioversion is indicated when a child who has a pulse shows signs of unstable supraventricular tachycardia or unstable ventricular tachycardia. Cardioversion should not be delayed to obtain IV access in an unstable child

SVT with synch markers on

Synchronized cardioversion at 50J

Look to the Experts

·         Stable patients may await expert consultation because treatment has the potential for harm.

·         Sequential use of 2 or more drugs may have adverse effects: bradycardia, hypotension, and torsades de pointes

·         Seek expert consultation for tachycardias not responsive to medications

·         Seek consultation for long term management

Sources

Sources

PALS Provider Manual. American Heart Association 7272 Greenville Ave. Dallas, Tx 75231

Kleinman ME, Chameides L, Schexnayder SM, Samson RA, Hazinski MF, Atkins DL, Berg MD, de Caen AR, Fink EL, Freid EB, Hickey RW, Marino BS, Nadkarni VM, Proctor LT, Qureshi FA, Sartorelli K, Topjian A, van der Jagt EW, Zaritsky AL. Part 14: pediatric advanced life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(suppl 3):S876–S908