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	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

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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