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PALS Wide QRS Tachycardia Adequate Perfusion Algorithm

22-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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