A 7-year-old presents with palpitations and a resting HR of 220 bpm. ECG shows a regular narrow complex tachycardia with no clearly visible P waves. BP is 90/60 mmHg. He is alert. The initial treatment of choice is:
- A Synchronized DC cardioversion 1 J/kg
- B Vagal maneuvers (ice bag on face); if unsuccessful IV adenosine ✓
- C IV adenosine 0.1 mg/kg rapid bolus with fast saline flush
- D IV verapamil 0.1 mg/kg over 2 minutes
Explanation
This is supraventricular tachycardia (SVT) — most common pediatric arrhythmia, narrow complex, regular, no P waves. In hemodynamically stable children, vagal maneuvers are the first step (diving reflex — ice bag on face is most effective in infants; Valsalva in older children). If unsuccessful, IV adenosine 0.1 mg/kg (max 6 mg) rapid bolus with fast flush is the drug of choice, exploiting its brief AV nodal blockade. IV verapamil is contraindicated in infants and young children (<1 year) due to risk of fatal cardiovascular collapse; caution under 5 years. Synchronized cardioversion is reserved for hemodynamically unstable SVT.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.