State of Wisconsin Emergency Medical Services

Sample Medical Guidelines ACLS-Pediatric SVT

Note: This protocol pertains to unstable children or those suspected of deterioration at any time. Stable children should be transported for evaluation. Remember children have higher underlying heart rates a thorough history of events is very important A!A suggests pulse rates for SVT are "#$% for ages #-$ years and "&&% for ages ne'born ( # year. !istory of the complaint is the )ey. SVT symptoms usually sho' a normal child suddenly deteriorating 'ith minimal or no history of other recent illness or in*ury Priorities
Chief Complaint ,P.RST Associated Symptoms0 Pertinent 1egative SA2PL3 4nitial 35am /etailed 7ocused 35am

;oals of Therapy 2onitoring

Assessment Findings +ea)ness any altered L,C signs of inade-uate perfusion /etermine onset of symptoms along 'ith possible causes. Respiratory distress chest pain nausea vomiting poor capillary refill Patient 'ith )no'n congenital heart defects respiratory insufficiencies and current medications. Assess A6Cs support air'ay and breathing as necessary. General Appearance8 Somnolent flaccid or poor muscle tone. Skin: Cool pale or gray. Respiratory Effort: 2ay be normal or signs of distress ie8 sub and intercostals retractions nasal flaring etc. Lung Sounds: 2ay be diminished or sound 9'et: due to poor cardiac output. Heart Sounds: may be distant or difficult to hear due to poor cardiac output. Extremities: Poor muscle tone 'ea) or no pulses mottled poor capillary refill Neuro: AL,C unresponsive /ecrease heart rate and restore normal perfusion
6P !R RR 3<; Sp,&.

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EMERGENC ME!"CAL RES#$N!ER %EMR&

Routine 2edical Care maintain normal body temperature Titrate o5ygen therapy to the lo'est level re-uired to maintain an o5ygen saturation greater than ?@A Assist ventilations as necessary =se air'ay ad*uncts as needed.

EMERGENC ME!"CAL 'ECHN"C"AN %EM'&

Continue air'ay support as needed using air'ay ad*uncts Assess blood glucose level if approved. 4f glucose BC% see Pediatric Hypoglycemia Guidelines Cardiac monitor as needed if approved.

A!(ANCE! EM' %AEM'&

4V04, access as needed if approved.

"N'ERME!"A'E
Attempt valsalva maneuvers as able by child ieD forceful cough cold pac)s on face and nec) or blo' through a stra' 3stablish 4V04, 1S. /o not 'ithhold 4, if unable to start 4V promptly and child is unstable 4f unable to maintain air'ay consider endotracheal 4ntubation 4f child is rapidly deteriorating perform immediate synchroniEed cardioversion at %.FG0)g. Consider pain management or sedation 4f time allo's may try Adenosine first at %.#mg0)g 4V or 4, being sure to administer rapidly and follo' 'ith a rapid fluid flush. /uring administration record a rhythm strip.

Contact Medical Control for the following: Repeat doses of Adenosine

#ARAME!"C
Sedation prior to cardioversion 'ith (ersed %.#mg0)g 4V04, Contact Medical Control for the following: Possible use of Amiodarone

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