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 |
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| 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 |
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|
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
