Narrow Complex Tachycardias

You are treating an 11-year-old with light-headedness.

Initial vitals demonstrate T: 36.5, R: 24, P: 180, BP: 70/40, O₂: 100%. Patient is awake and talking. You ask for initial EKG which demonstrates the following:
1. What are next step in management?*
- Cardioversion
- Lidocaine
- Amiodarone
- Defibrillate

You successfully cardiovert the patient.

Repeated EKG demonstrates normal sinus rhythm. The nurse calls you back into the room because the patient reports feeling light-headed with palpitations. Patient is awake and talking. Repeat vitals demonstrate the following, T: 36.5, P: 200, R: 16, O₂: 100%, BP: 100/60.
Rhythm strip demonstrates the following:
2. What is the appropriate medication and dosing for treatment?*
- Amiodarone - 5mg/kg
- Adenosine - 0.1mg/kg
- Lidocaine - 1.5 mg/kg
- Epinephrine - 0.01 mg/kg

The patient’s symptoms and rhythm strip are unchanged after initial dosage of Adenosine.
3. What is the next step in management?*
- Cardiovert
- Vagal maneuvers and Adenosine - 0.2mg/kg
- IVFs
- Intubate