Treat underlying cause
Vagal stimulation (if will not delay medications/cardioversion)
Infants/young children: apply ice to face
Older children: Carotid sinus massage / Valsalva
Synchronized cardioversion
Use if unstable or adenosine ineffective
Give 0.5-1 J/kg; if unsuccessful increase to 2 J/kg
Give 2nd shock consider amiodarone OR procainamide before 3rd shock
Amiodarone  5mg/kg over 20-60min
Procainamide 15mg/kg over 30-60min
Adenosine
0.1mg/kg; immediately flush with 5cc normal saline
Infants/young children: apply ice to face
Older children: Carotid sinus massage / Valsalva
Use if unstable or adenosine ineffective
Give 0.5-1 J/kg; if unsuccessful increase to 2 J/kg
Give 2nd shock consider amiodarone OR procainamide before 3rd shock
Amiodarone  5mg/kg over 20-60min
Procainamide 15mg/kg over 30-60min
Give 2nd shock consider amiodarone OR procainamide before 3rd shock
Amiodarone  5mg/kg over 20-60min
Procainamide 15mg/kg over 30-60min
Amiodarone  5mg/kg over 20-60min
Procainamide 15mg/kg over 30-60min
0.1mg/kg; immediately flush with 5cc normal saline
PALS: Tachycardia
ACLS: Tachycardia
PALS: Bradycardia
ACLS: Bradycardia
Harbor Macros: Chest Pain
Harbor Macros: Syncope
Harbor Macros: Abdominal Pain
Ultrasound: In Shock and Hypotension