PALS: Tachycardia

Background

• Algorithm assumes pulse and adequate perfusion

Narrow-Complex

• Sinus tachycardia - treat underlying cause
• Supraventricular
  • Vagal stimulation (if will not delay meds/cardioversion)
    • Infants/young children: apply ice to face
    • Older children: Carotid sinus massage / Valsalva
  • Synchronized cardioversion
    • Use if unstable or adenosine ineffective
    • Give 0.5-1 J/kg; if unsuccessful increase to 2 J/kg
      • Give 2nd shock consider amiodarone OR procainamide before 3rd shock
        • Amiodarone 5 mg/kg over 20-60min
        • Procainamide 15 mg/kg over 30-60min
  • Adenosine
    • 0.1 mg/kg; immediately flush w/ 5cc NS

Wide-Complex

• Adenosine for differentiating SVT from VT
  • Consider only if rhythm is regular and QRS monomorphic
• Synchronized cardioversion
  • Give 0.5-1 J/kg; if unsuccessful increase to 2 J/kg
  • Give 2nd shock consider amiodarone OR procainamide before 3rd shock
    • Amiodarone 5 mg/kg over 20-60min
    • Procainamide 15 mg/kg over 30-60min

See Also

• PALS (Main)
• ACLS: Tachycardia
• SVT

Source

AHA 2010 Guidelines for PALS