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PALS Narrow QRS Tachycardia Adequate Perfusion Algorithm

21-PALS-Narrow-QRS-Tachycardia-Adequate-Perfusion-Algorithm

1. Tachycardia is diagnosed by manual testing or heart rate monitor and the child has adequate perfusion – 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

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

2. Consider possible causes but do not delay treatment

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

Determine rhythm

  • Sinus tachycardia – Determine cause and treat
  • Supraventricular tachycardia
    • Consider vagal maneuvers
    • Consider adenosine 0.1 mg/kg rapid IV up to 6 mg in first dose
    • May repeat adenosine at 0.2 mg/kg up to 12 mg in 2nd dose
    • Consider amiodarone or procainamide
    • Consider cardioversion at 0.5 to 1 Joule/kg
    • Second cardioversion dose at 2 Joules/kg
    • Consult pediatric cardiologist
    • Continue to search for treatable causes of tachycardia and treat promptly

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