Verse 1 Tone out — pediatric call in the night, Wide on the monitor, QRS not tight. Over point zero nine seconds seen, This isn’t always what it seems. I run the history as I move fast, Past medical notes from the child’s past. Aminophylline, diet pills in play, Thyroid meds or decongestants today. Digoxin levels, toxic surprise, Nicotine, cocaine — red-flag signs. Congenital heart disease in mind, Respiratory distress we may find. Syncope or near syncope too, What’s been happening? What did they do? Chorus Wide complex tachycardia — don’t assume, Assess the child in the clinical room. Heart rate high — child over 180, Infant over 220 — urgency. Pale or cyanotic, sweating and cold, Vomiting, tachypnea, stories unfold. Hypotension, altered state, Pulmonary congestion — don’t hesitate. Is it stable or unstable now? Find the cause — that’s the vow. Verse 2 I check the differential line by line: Hypo or hyperthermia signs. Hypovolemia, anemia low, Electrolytes out of flow. Fever, infection, sepsis in sight, Hypoxia, hypoglycemia fight. Anxiety, pain, emotional stress, Trauma, tension pneumothorax. Pulmonary embolus can’t ignore — Underlying cause is the core. Assess tachycardia in context wide, Treat what’s causing it — not just the ride. Pre-Chorus Cardiac monitor, pads in place, Anterior-posterior for pacing space. IV or IO protocol set, Single-lead rhythm — we’re not done yet. 12-lead later when stable and calm, Right now we focus on the harm. If at any time there’s no pulse felt, Switch to pediatric arrest — don’t wait or melt. Chorus Wide and worrying — look at the strip, Monomorphic or polymorphic. Regular rhythm? Check it twice, SVT with aberrancy — think it through nice. But VT in kids — uncommon sight, Often structural heart disease in the fight. Rates can vary — near normal to high, But symptoms tell us how to try. Bridge If QRS is regular and tight in line, Adenosine may help define. Point two milligrams per kilo IV/IO push, Max twelve milligrams — steady and brusque. May repeat one time if needed be, But watch the rhythm carefully. If no response and VT appears, Amiodarone comes through the gears. Five milligrams per kilo infusion slow, In one-hundred mL over ten minutes go. Max one-fifty milligrams total dose, Medical control — we stay close. Verse 3 Unstable signs — AMS, shock, Hypotension — time to act. Synchronized cardioversion plan, One joule per kilo — that’s the scan. Repeat at two, then up to four, Adult max if weight asks for more. Consider sedation to ease the pain, Midazolam in proper range. Point two mg per kilo dose, IV, IO, IN, IM close. May repeat every three to five, Watch breathing — keep them alive. Max single dose two milligrams here, Total five — stay clear and near. Chorus (Final) Torsades can twist the wide complex line, Polymorphic changes from beat to beat design. Rate one-fifty to two-fifty fast, Long QT or drugs in the past. Low magnesium, potassium low, Can make that rhythm start to go. Watch closely — it can deteriorate, Monitor, reassess, don’t hesitate. Most important goal in view: Is it stable? What’s the clue? Differentiate rhythm, treat with care, Context decides how we prepare. Outro Mental status, skin, and neck, Lungs, heart, abdomen — check. Extremities, neuro — complete exam, Every step part of the plan. Wide complex — we don’t just guess, We find the cause and reassess. From monitor beep to hospital light, We guide the child through the fight.
