PALS: Tachycardia
This page is for pediatric patients; for adult patients see ACLS: Tachycardia
Background
- Algorithm assumes pulse and adequate perfusion
Narrow-Complex
Sinus tachycardia
- Treat underlying cause
Supraventricular
- Vagal stimulation (if will not delay medications/cardioversion)
- Infants/young children: apply ice to face
- Older children: Carotid sinus massage / Valsalva
- Synchronized cardioversion
- Use if unstable or adenosine ineffective
- Give 0.5-1 J/kg; if unsuccessful increase to 2 J/kg
- Give 2nd shock consider amiodarone OR procainamide before 3rd shock
- Amiodarone 5mg/kg over 20-60min
- Procainamide 15mg/kg over 30-60min
- Give 2nd shock consider amiodarone OR procainamide before 3rd shock
- Adenosine
- 0.1mg/kg; immediately flush with 5cc normal saline
Wide-Complex
- Adenosine for differentiating SVT from ventricular tachycardia
- Consider only if rhythm is regular and QRS monomorphic
- Synchronized cardioversion
- Give 0.5-1 J/kg; if unsuccessful increase to 2 J/kg
- Give 2nd shock consider amiodarone OR procainamide before 3rd shock
- Amiodarone 5mg/kg over 20-60min
- Procainamide 15mg/kg over 30-60min
References
AHA 2010 Guidelines for PALS
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