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Tachycardia Flashcards

7 cards from real PALS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

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  1. A 5-year-old presents with palpitations, pallor, and a heart rate of 240 bpm. After ice pack application to the face, the rate abruptly converts to 95 bpm. What rhythm did this child most likely have?

    Answer: SVT

    The abrupt conversion to normal rate following a vagal maneuver (ice pack facial immersion) is characteristic of SVT, which terminates abruptly rather than gradually.

  2. Which ECG finding is most characteristic of ventricular tachycardia (VT) compared to SVT with aberrancy?

    Answer: AV dissociation visible on the tracing

    AV dissociation (independent P waves and QRS complexes) is a classic marker of ventricular tachycardia that helps distinguish it from SVT with aberrancy.

  3. A 9-year-old with Wolff-Parkinson-White (WPW) syndrome develops rapid atrial fibrillation. Which drug should be AVOIDED?

    Answer: Adenosine

    Adenosine (and AV nodal blocking agents) should be avoided in WPW with atrial fibrillation as they can accelerate conduction through the accessory pathway, causing VF.

  4. What is the correct energy dose for the SECOND attempt at synchronized cardioversion in a child with unstable SVT if the first attempt at 1 J/kg was unsuccessful?

    Answer: 2 J/kg

    PALS guidelines recommend escalating synchronized cardioversion from 0.5-1 J/kg to 2 J/kg for the second and subsequent attempts.

  5. A nurse asks why the defibrillator must be in 'synchronized' mode before cardioverting SVT. What is the correct explanation?

    Answer: To avoid delivering a shock during the vulnerable T-wave period

    Synchronized cardioversion delivers the shock on the R wave to avoid the vulnerable T-wave repolarization period, which could trigger ventricular fibrillation.

  6. In a 2-month-old infant with confirmed SVT who is mildly symptomatic, what is the preferred initial pharmacological treatment?

    Answer: Adenosine 0.1 mg/kg rapid IV

    Adenosine 0.1 mg/kg rapid IV is the first-line pharmacological treatment for SVT in infants when vagal maneuvers fail, regardless of age.

  7. A child in SVT has an IV established in the hand. Adenosine is ordered. Compared to a central line or antecubital IV, what adjustment should be made?

    Answer: Use an even faster flush and ensure rapid delivery to central circulation

    When adenosine is given via a distal peripheral IV, a very rapid flush of 5-10 mL NS must immediately follow to push the drug centrally before it degrades.