A 4-year-old child is brought with sudden onset palpitations and HR 220/min on ECG. The ECG shows a narrow complex regular tachycardia with absent visible P waves. BP is 90/60 mmHg. He has no structural heart disease. What is the CORRECT first-line management?

• A Vagal maneuvers (ice-cold wet cloth to face) ✓
• B Synchronized DC cardioversion at 0.5–1 J/kg
• C IV adenosine 0.1 mg/kg rapid bolus
• D IV adenosine 0.05 mg/kg rapid bolus

Explanation

This is supraventricular tachycardia (SVT) — the most common symptomatic arrhythmia in children. In a hemodynamically stable patient (BP 90/60 mmHg, no shock), the first-line treatment is vagal maneuvers. In infants, the diving reflex is elicited by applying an ice-cold wet cloth or ice bag to the face for 15–30 seconds. In older children, Valsalva or carotid sinus massage is used. If vagal maneuvers fail, IV adenosine is the pharmacological treatment of choice at a dose of 0.1 mg/kg (max 6 mg first dose) given as a rapid IV bolus. Synchronized cardioversion is reserved for unstable SVT with hemodynamic compromise. The lower dose of 0.05 mg/kg is insufficient and not a standard PALS dose for SVT.

Reference: Ghai Essential Pediatrics, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.