Ventricular Tachycardia with Pulse Pediatric Dose — Cardioversion
Synchronized cardioversion is the electrical treatment of choice for hemodynamically significant ventricular tachycardia (VT) with a pulse in pediatric patients. By delivering a shock synchronized to the R-wave, it terminates reentrant arrhythmias while minimizing the risk of inducing ventricular fibrillation. It is a core intervention within the PALS algorithm for unstable tachyarrhythmias with a pulse.
Pediatric Dosing
For synchronized cardioversion of ventricular tachycardia with pulse, the recommended energy dose is 0.5–2 J/kg, delivered as a synchronized shock.
- Initial dose: 0.5–1 J/kg
- Subsequent doses (if initial attempt unsuccessful): up to 2 J/kg
Consult institutional protocol regarding maximum absolute energy limits and escalation strategy. For a 20 kg child: initial dose = 20 × 0.5 J/kg = 10 J; maximum dose = 20 × 2 J/kg = 40 J.
Indications and Clinical Context
Synchronized cardioversion is indicated for ventricular tachycardia in the pediatric patient who retains a pulse but demonstrates hemodynamic instability (e.g., altered mental status, hypotension, poor perfusion, or respiratory distress). In the PALS framework, VT with a pulse falls under the unstable tachyarrhythmia pathway, where immediate cardioversion is prioritized over pharmacologic management. If the patient is stable, expert consultation and antiarrhythmic therapy may be considered first.
Synchronization is critical: the device must be confirmed to be in synchronized mode before each shock delivery, as defibrillator synchronization may revert to unsynchronized mode after each discharge.
Administration and Monitoring
Deliver the shock via anterolateral or anteroposterior pad/paddle placement appropriate for the child’s size. Confirm synchronized mode is active (a marker should appear on each detected R-wave on the monitor) before charging. Sedation and analgesia should be provided whenever the clinical situation permits, as cardioversion is painful in a conscious patient. Ensure continuous cardiac monitoring, pulse oximetry, and availability of resuscitation equipment throughout the procedure.
- Route: Transcutaneous (pads or paddles)
- Mode: Synchronized — verify before each attempt
- Sedation: Provide if patient condition allows
- Post-shock: Reassess rhythm and hemodynamics immediately
- Key risk: Unsynchronized delivery may precipitate ventricular fibrillation; always confirm sync mode
Disclaimer: This article is an educational reference summarizing standard pediatric dosing values. It is not a substitute for clinical judgment. Always verify doses against institutional protocols, the current edition of authoritative references (e.g., Lexicomp, Harriet Lane Handbook, PALS guidelines), the patient’s accurate weight, and any patient-specific factors (renal/hepatic function, allergies, comedications) before administration.