FIELD REFERENCE
Full criteria & treatment guidance
Indications
- Regular narrow-complex tachycardia with a pulse; apply the adult SO-C-025 criteria. Pediatric use requires a base order.
Contraindications & local exclusions
- IV adenosine: known hypersensitivity; second- or third-degree AV block; sinus-node disease or symptomatic bradycardia, unless the patient has a functioning pacemaker for the conduction exclusions. OCEMS does not use this pathway for a wide, irregular rhythm.
Precautions
- Avoid in bronchoconstriction/bronchospasm; be ready for transient heart block or asystole. Monitor rhythm continuously. Do not repeat after high-grade block. Use rapid IV; PR-115 identifies IO adenosine as ineffective. The cited IV label identifies carbamazepine as increasing the risk of higher-degree heart block; dipyridamole potentiates adenosine, while caffeine/theophylline antagonize its effect. These are interaction precautions, not a new set of OCEMS contraindications or permission to change the protocol dose.
- These are selected safety checks, not a complete prescribing monograph. Product labeling and OCEMS authorization answer different questions; confirm the actual product, patient population and applicable order.
Check before giving
- Do not use for a wide, irregular rhythm.
- PR-115 specifically identifies IO administration as ineffective for adenosine; this pathway is rapid IV.
Use in OCEMS
- For a regular narrow-complex tachycardia with a pulse. The adult SO-C-025 pathway distinguishes mild symptoms from hemodynamic instability.
- For mild symptoms at a rate of at least 150/min, attempt Valsalva before the medication pathway.
Adult / adolescent
| Indication / route | Dose & limits |
|---|---|
| Regular narrow-complex tachycardia ≥150/min | 12 mg rapid IV. If the rhythm persists, repeat 12 mg once after 3 minutes. |
| Unstable presentation | Follow the synchronized-cardioversion branch of SO-C-025; do not delay urgent electrical treatment to complete a medication sequence. |
Pediatric
- I-20 marks pediatric adenosine as requiring a base hospital order. It provides separate first- and second-dose rows for each weight band.
- Use the ordered dose and the matching weight-band chart; do not apply the adult 12 mg initial dose to a child. I-20 uses a 3 mg/mL preparation.
Pediatric weight bands — base-ordered adenosine
- I-20 pages 1–10: base hospital order required. Rapid IV route; preparation 3 mg/mL. PR-115 states adenosine is not effective through an IO site.
- These are the published I-20 band doses, not exact-weight calculations. Confirm the actual order and prepared volume against the linked chart; do not extrapolate outside its listed bands.
| I-20 weight band | First dose — rapid IV | Second dose — rapid IV |
|---|---|---|
| 3–5 kg | 0.4 mg | 0.8 mg |
| 6–7 kg | 0.6 mg | 1.2 mg |
| 8–9 kg | 0.8 mg | 1.6 mg |
| 10–11 kg | 1 mg | 2 mg |
| 12–14 kg | 1.2 mg | 2.4 mg |
| 15–18 kg | 1.5 mg | 3 mg |
| 19–23 kg | 2 mg | 4 mg |
| 24–29 kg | 2.5 mg | 5 mg |
| 30–36 kg | 3.5 mg | 7 mg |
| 37–49 kg | 4.5 mg | 9 mg |
Preparation & reassessment
- Record the rhythm before and after administration and reassess perfusion and symptoms.
- Confirm the actual syringe concentration and dose. A vial or syringe size is not the ordered dose.
VISUAL FIELD REFERENCE
Adenosine: adult and pediatric authority differ
Adult & pediatric guidance · ALS
Use the appropriate rhythm, symptom, and Valsalva pathway before medication.
Adult regular narrow-complex rhythm ≥150/min
12 mg rapid IV. If the rhythm persists, repeat 12 mg once after 3 minutes.
Pediatric
I-20 marks pediatric adenosine as requiring a base hospital order. It provides separate first- and second-dose rows for each weight band.
Use the ordered dose and the matching weight-band chart; do not apply the adult 12 mg initial dose to a child. I-20 uses a 3 mg/mL preparation.
- Do not use for a wide, irregular rhythm.
- PR-115 specifically identifies IO administration as ineffective for adenosine; this pathway is rapid IV.
- Follow the synchronized-cardioversion branch of SO-C-025; do not delay urgent electrical treatment to complete a medication sequence.
Selected checkpoints; read the complete guide for criteria, exclusions, doses, and ongoing care. I-15 · I-20 · SO-C-025 · PR-115
UNDERSTAND THE CARE
Why the route and rhythm checks come before the syringe
The adult pathway requires a regular narrow rhythm with the appropriate symptoms and rate branch. Assess perfusion and possible hypovolemia before treating the monitor number. The pediatric chart provides base-ordered weight-band doses; it is not permission to apply the adult initial dose to a child.
Applying the guidance
Preparation should identify the actual concentration, intended milligrams and measurable volume. Keep the rapid IV administration instructions available and record a rhythm strip before and after treatment. Reassess pressure and symptoms as well as conversion. A vial or syringe capacity does not establish the dose, and the linked IO procedure identifies adenosine as ineffective through that route.
Dose, concentration and volume
Diagram text & teaching checkpoints
- Rhythm and perfusion
- Confirm the eligible branch.
- Authority
- Adult order or pediatric base direction.
- Administration
- Exact dose, concentration and rapid IV technique.
- Response
- Rhythm strip, symptoms and pressure.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.
- I-15 — Adult / Adolescent Standing Order Drug Guide
- I-20 — Pediatric Medication Volume Dose by Weight
- SO-C-025 — Narrow Complex QRS Complex Tachycardia
- PR-115 — Intraosseous Infusion
- Product label — ADENOSINE injection
- AHA 2025 — technique — Adult tachyarrhythmia algorithm — normal-saline flush; not OCEMS dosing authorization
Read back the rhythm, route and ordered amount
Before preparation, name the rhythm and the clinical branch being treated. The adult order describes regular narrow-complex tachycardia and distinguishes the mild-symptom medication branch from the unstable electrical-treatment branch. The fact that adenosine is listed on the medication page does not mean it belongs in every fast-rhythm encounter.
For a child, state the base order and the matching I-20 weight band before preparing the syringe. The table contains published band doses, not a formula to apply to a different weight or a reason to use the adult initial dose. Read back the amount in milligrams, the actual concentration and the resulting volume; include the rapid-IV route explicitly.
Preserve a rhythm record around administration and describe the subsequent rate, rhythm, perfusion and symptoms. If another dose is considered, confirm what was already given and the permitted interval rather than treating a new clinician’s arrival as a new sequence. An IO in place does not establish that this rapid-IV adenosine pathway is available through that site.