From the Guidelines
The PALS protocols for arrhythmias prioritize early recognition and treatment of abnormal heart rhythms in pediatric patients, with a focus on high-quality CPR, timely defibrillation, and appropriate medication administration to restore normal cardiac rhythm and maintain tissue perfusion. For bradycardia with poor perfusion, start with effective oxygenation and ventilation, then administer epinephrine 0.01 mg/kg (0.1 mL/kg of 1:10,000 solution) IV/IO every 3-5 minutes if heart rate remains below 60 bpm with signs of poor perfusion despite adequate ventilation 1. For tachycardia, first determine if the rhythm is narrow complex (supraventricular tachycardia) or wide complex (ventricular tachycardia). For SVT with poor perfusion, perform synchronized cardioversion at 0.5-1 J/kg, increasing to 2 J/kg if unsuccessful. If the patient is stable, adenosine 0.1 mg/kg (maximum first dose 6 mg) rapid IV push can be given, followed by 0.2 mg/kg (maximum 12 mg) if needed.
Key Considerations
- For ventricular fibrillation or pulseless ventricular tachycardia, begin high-quality CPR immediately, defibrillate at 2 J/kg (increasing to 4 J/kg for subsequent shocks), and administer epinephrine 0.01 mg/kg every 3-5 minutes 1.
- Amiodarone 5 mg/kg IV/IO or lidocaine 1 mg/kg IV/IO can be given after the second shock, with the choice of medication guided by the patient's specific clinical scenario and the provider's expertise 1.
- The use of automated external defibrillators (AEDs) is recommended for children 1 to 8 years of age who have no signs of circulation, with the device ideally delivering a pediatric dose and having an arrhythmia detection algorithm with high specificity for pediatric shockable rhythms 1.
Protocol Summary
- Verify scene safety and check for responsiveness
- Activate the emergency response system and retrieve the AED or defibrillator
- Start CPR with cycles of 30 compressions and 2 breaths for a single rescuer, or 15 compressions and 2 breaths for two rescuers
- Use the AED as soon as it is available and follow the device's prompts for shock delivery and rhythm checking 1.
From the FDA Drug Label
The FDA drug label does not answer the question.