For a stable pediatric patient with wide complex tachycardia consistent with undifferentiated VT; SVT with aberrancy suspected, what is the recommended adenosine dosing sequence?

For a stable pediatric patient with wide complex tachycardia consistent with undifferentiated VT; SVT with aberrancy suspected, what is the recommended adenosine dosing sequence?

• A. AMIODARONE 5 mg/kg; then synchronized cardioversion
• B. MAGNESIUM SULFATE 25 mg/kg; then magnesium rescue
• C. ADENOSINE 0.1 mg/kg IV/IO, max 6 mg; if unsuccessful, 0.2 mg/kg IV/IO, max 12 mg
• D. Synchronized cardioversion and sedation with ETOMIDATE

Answer: (C)

In a stable pediatric patient with wide-complex tachycardia where SVT with aberrancy is suspected, adenosine is used both diagnostically and therapeutically to reveal whether the rhythm is AV nodal–dependent SVT. Adenosine temporarily blocks AV nodal conduction, which can terminate reentrant SVT and often reveals a more regular or narrow complex rhythm if SVT is the cause. The recommended dosing sequence is a first rapid IV/IO bolus of 0.1 mg/kg (maximum 6 mg); if there’s no response, give a second dose of 0.2 mg/kg (maximum 12 mg). This approach is chosen because the patient is stable and adenosine can help determine if SVT with aberrancy is present without immediately resorting to cardioversion. If adenosine fails to terminate or if instability develops, then other interventions such as synchronized cardioversion are indicated.

In a stable pediatric patient with wide-complex tachycardia where SVT with aberrancy is suspected, adenosine is used both diagnostically and therapeutically to reveal whether the rhythm is AV nodal–dependent SVT. Adenosine temporarily blocks AV nodal conduction, which can terminate reentrant SVT and often reveals a more regular or narrow complex rhythm if SVT is the cause. The recommended dosing sequence is a first rapid IV/IO bolus of 0.1 mg/kg (maximum 6 mg); if there’s no response, give a second dose of 0.2 mg/kg (maximum 12 mg). This approach is chosen because the patient is stable and adenosine can help determine if SVT with aberrancy is present without immediately resorting to cardioversion. If adenosine fails to terminate or if instability develops, then other interventions such as synchronized cardioversion are indicated.