PALS Narrow 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

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 2nd dose
- Consider amiodarone or procainamide
- Consider cardioversion at 0.5 to 1 Joule/kg
- Second cardioversion dose at 2 Joules/kg
- Consult pediatric cardiologist
- Continue to search for treatable causes of tachycardia and treat promptly

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