Calling this week's protocol the one for pediatric dysrhythmias is a bit of a misnomer, as severe bradycardia in kids is managed elsewhere. When it comes to tachydysrhythmias, however, this protocol has you covered! If BLS is on scene with one of these kids, they’ll request ALS backup, but they are instructed not to allow this to delay transport. So don’t be surprised if EMTs arrive with a tachycardic kid with minimal interventions; just realize that our ED may have been closer than the closest paramedics. If ALS is on scene, it’s all about recognition and identification of the dysrhythmia. Stable SVT are treated with vagal maneuvers, with adenosine available as a Medical Control Option as backup after calling OLMC. Cases of unstable SVT and VT with a pulse will always come through OLMC, at which point you and the paramedics can discuss synchronized cardioversion. Remember to utilize weight-based energy settings, and consider sedation options for your conscious patients.
It may come as a…shock…to you all, but there are some subtle differences here between this protocol and its adult counterpart, so be sure to…slow down…and read through it, carefully? Idk, I’m writing less of these now, I’m rusty.
www.nycremsco.org and the protocol binder for more.
Dave