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	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

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

Narrow QRS Complex

Determine rhythm

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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