Call for defibrillator and code cart. Place patient on backboard. Attach defibrillator pads

Increase O₂ to 100%, stop anesthetic agents, inform surgeon, consider cardiology consult

If NO pulse present, start CPR/PALS; go to CARDIAC ARREST

If pulse present, Pick One

Narrow complex (p waves before every QRS)

Probably sinus tachycardia

Identify and treat underlying etiology

SVT, tachyarrythmia

Consider vagal maneuvers

Adenosine 1st dose 0.1 mg/kg IV, rapid push (6 mg MAX); 2^nd dose 0.2 mg/kg IV (12 mg MAX)

Synchronized cardioversion: 0.5-1 joule/kg, additional shocks @ 2 joules/kg

Wide complex

Amiodarone 5 mg/kg IV bolus over 20-60 min

OR

Procainamide 15 mg/kg IV bolus over 30-60 min

OR

Synchronized cardioversion: 0.5-1 joule/kg, additional shocks @ 2 joules/kg

Torsade de Pointes (polymorphic VT with prolonged QT)

Magnesium sulfate 25-50 mg/kg IV/IO (MAX 2 g)

Lidocaine 1 mg/kg IV (MAX 100 mg)

Sodium bicarbonate (for quinidine-related SVT) 1 mEq/kg IV

Temporary TRANSCUTANEOUS PACING

Crisis Management (If Severe)

Notify surgeon, call for help and code cart

Call for Transesophageal Echocardiography

Start chest compressions

Give epinephrine 10 MICROgrams/kg IV/IO

If cardiac arrest, go to CARDIAC ARREST

Consider ECMO