PALS Tachycardia Initial Management Algorithm

1. Tachycardia is diagnosed by manual testing or heart rate monitor– Normal heart rates vary with age/size.

2. Consider possible causes but do not delay treatment

• Vagal Maneuvers
• Synchronized Cardioversion
• Medications
• Support Airway, Breathing, Circulation

3. Is the child stable or unstable?

A child with tachycardia is considered unstable if he or she is hypotensive, has a decreased level of consciousness, is in shock, or is experiencing ischemic chest pain.

Unstable child – administer synchronized cardioversion immediately

For synchronized cardioversion, begin with an electrical dose of 0.5 to 1 J/kg of the child’s body weight. If ineffective, increase the energy level to 2 J/kg. For defibrillation (cardiac arrest with a shockable rhythm), first shock should be given at 2 J/kg and the second shock should be given at 4 J/kg. Subsequent shocks may be higher, up to the adult maximum of 10 J/kg body weight.

Stable child – continue assessment

Age Category	Age Range	Systolic Blood Pressure	Diastolic Blood Pressure	Abnormally Low Systolic Pressure
Neonate	1 Day	60-76	30-45	<60
Neonate	4 Days	67-84	35-53	<60
Infant	To 1 month	73-94	36-56	<70
Infant	1-3 months	78-103	44-65	<70
Infant	4-6 months	82-105	46-68	<70
Infant	7-12 months	67-104	20-60	<70 + (age in years x 2)
PreSchool	2-6 years	70-106	25-65	<70 + (age in years x 2)
School Age	7-14 years	79-115	38-78	<70 + (age in years x 2)
Adolescent	15-18 years	93-131	45-85	<90

4. Assess the child’s tissue perfusion

If tissue perfusion is poor, move directly to the PALS Tachycardia Poor Perfusion Algorithm

If tissue perfusion is adequate…

5. Measure the width of the child’s QRS complex on ECG

If the QRS complex is narrow (QRS ≤0.09 sec), move to the PALS Narrow QRS Tachycardia Adequate Perfusion Algorithm

If the QRS complex is wide (QRS >0.09 sec), move to the PALS Wide QRS Tachycardia Adequate Perfusion Algorithm