Birmingham Children’s Hospital ED Handbook Version 1 (2011)

(1.6) SUPRAVENTRICULAR TACHYCARDIA

Characteristics of SVT (as compared with sinus tachycardia) Vagal manoeuvres

220 bpm in infants (> 180 bpm in older children). Diving reflex (face immersed in
Negative P waves in II, III, aVF. iced water for 5 secs or ice in
glove applied to face)
No beat-to-beat variability.
1-sided carotid sinus manage
Abrupt termination.
Valsalva manoeuvre (e.g. blowing
Less likely to have a history consistent with shock. plunger out of a 50 ml syringe)

MANAGEMENT OF SUPRAVENTRICULAR TACHYCARDIA (SVT)

YES Shock NO
present?

Vagal manoeuvre
Vagal manoeuvre
If no delays

Vascular YES Adenosine 100 mcg/kg

access quicker
than setting up with rapid saline flush
defibrillator?
2 mins

NO
Adenosine 200 mcg/kg
with rapid saline flush
Synchronous DC
shock 1 J/kg
2 mins

Adenosine 300 mcg/kg

with rapid saline flush

Synchronous DC
shock 2 J/kg

Consider:
Adenosine 400 – 500 mcg/kg
Max dose 12 mg
Consider
Neonates: max 300 mcg/kg
amiodarone
Synchronous DC shock
Amiodarone or other antiarrhythmic
(discuss with cardiology)

Reference
APLS The Practical Approach (5th Edition)