Wide Complex Tachycardia with a pulse

Assessment

Pediatric Pearls: Signs & Symptoms: Differential: 
□ Use approved reference document for medication dosing, electrical therapy, and equipment sizes. 
□ Focus on rapid and early BLS airway and ventilation tools. Intubation may not be the best option for these patients. 
□ Pediatric pads should be used in children <25 Kg.		□ QRS > 0.12 sec 
□ Ventricular tachycardia on ECG (runs or sustained) 
□ Conscious, rapid pulse 
□ Chest pain 
□ Shortness of breath 
□ Dizziness 
□ Rate usually 150-180 bpm for sustained V-tach		□ Artifact / Device failure 
□ Cardiac history 
□ Endocrine / Electrolyte 
□ Hyperkalemia 
Drugs / Toxic exposure 
□ Pulmonary disease 
□ Tricyclic OD

Clinical Management Options

EMT-B
• Oxygen, PRN titrated to SpO2 92%-96% 
Basic airway management 
Paramedic
• Vascular access 
• Obtain EKG
• Monitor ETCO2
• Vascular access 
• Isotonic Crystalloid PRN titrated to SBP > 100 mmHg or MAP > 65 
• Unstable Wide complex tachycardia, sedate and cardiovert
• Adults: Synchronize cardioversion at the maximum Joules 
• Pediatric Cardioversion: 1J/kg then repeat at 2J/kg as needed
• 12 lead ECG post conversion 
• If Torsades, give Magnesium
• If Tricyclic OD, consider Sodium Bicarbonate early 
• If Hyperkalemia, Calcium, Sodium Bicarbonate, and Albuterol
Consult Online Medical Control as Needed

Pearls

  • For witnessed / monitor ventricular tachycardia, try having patient cough while preparing other therapies. 
  • Wide complex between 100 – 140 beats/min, consider Hyperkalemia.
  • Consider a change of vector if initial Cardioversion is unsuccessful to anterior/posterior pad placement.