PALS Tachycardia Initial Management Algorithm

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

Age Category

Age Range

Normal Heart Rate

Newborn 0-3 months 80-205 per minute
Infant/Young child 4 months to 2 years 75-190 per minute
Child/School Age 2-10 years 60-140 per minute
Older child/ Adolescent Over 10 years 50-100 per minute

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

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