PALS Wide QRS Tachycardia Adequate Perfusion Algorithm

PALS Wide 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

  • Possible SVT with QRS aberrancy – Follow PALS Narrow QRS Tachycardia Adequate Perfusion Algorithm and use the supraventricular rhythm pathway. Continue to reassess vitals, cardiovascular status, and tissue perfusion. Be prepared to treat for ventricular tachycardia/ventricular fibrillation.
  • Ventricular tachycardia (may deteriorate to ventricular fibrillation or unstable or pulseless ventricular tachycardia!)
    • Consider amiodarone (5 mg/kg IV over 20 to 60 minutes) OR procainamide (15 mg/kg IV over 30 to 60 minutes)
    • 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 cardioversion at 0.5 to 1 Joule/kg
    • Second cardioversion dose at 2 Joules/kg
    • Consult pediatric cardiologist
    • Search for and treat reversible causes
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