PALS TACHYCARDIA

PALS Tachycardia

1) Are they stable or unstable?

2) QRS Wide or Narrow?

2a) QRS > 90ms (2.25 small boxes) – possible VT

2b) QRS < 90ms – probably SVT if history of abrupt rate change, absent/abnormal p-

waves, non-variable HR, HR > 220 in infants or 180 in children

2c) probably sinus tach if  history of known cause, normal p-wave morphology, variable R-R, constant P-R interval, HR < 220 in infants, or 180 in children

3) **Unstable = shock 0.5-1 J/kg, increase to 2 J/kg if ineffective

4) stable wide complex tachycardia – consider adenosine if regular rhythm and monomorphic (do not delay defibrillation though… if unsure use electricity)

• adenosine 0.1 mg/kg rapid IV push, max 6mg,
• second dose 0.2 mg/kg rapid IV push, max 12mg

4b) amiodarone 5mg/kg IV/IO over 20-50 minutes OR procainamide 15mg/kg IV/IO over 30-60 minutes

5) narrow complex – probable SVT

5a) consider vagal maneuvers – ice bath, carotid sinus massage, or any Valsalva (REVERT trial?)

5b) adenosine as above or synchronized DCCV if no vascular access

6) If probable sinus tachycardia: search for and treat the cause NOT the HR