PALS Tachycardia Poor Perfusion Algorithm

PALS Tachycardia Poor Perfusion Algorithm

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

3. Is the QRS Complex narrow (≤0.09 sec) or wide (>0.09 sec)?

Narrow QRS Complex

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 second dose
    • Consider amiodarone or procainamide
    • Consider cardioversion at 0.5 to 1 Joule/kg
    • Second cardioversion dose at 2 Joules/kg

Wide QRS Complex

4. Is the child compromised?

Unstable – Provide immediate synchronized cardioversion

Cardioversion Rules

QRS narrow and regular 50-100 Joules
QRS narrow and irregular 120-200 Joules
QRS wide and regular 100 Joules
QRS wide and irregular Turn off the synchronized mode and defibrillate immediately

Stable

  • 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 second dose
  • Consider amiodarone (5 mg/kg IV over 20 to 60 minutes) OR procainamide (15 mg/kg IV over 30 to 60 minutes)
  • Consult pediatric cardiologist
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