PALS: tachycardia

Background

• Algorithm assumes pulse and adequate perfusion

Narrow-Complex

Sinus tachycardia

• Treat underlying cause

Supraventricular

• Vagal stimulation (if will not delay medications/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 5mg/kg over 20-60min
      • Procainamide 15mg/kg over 30-60min
• Adenosine
  • 0.1mg/kg; immediately flush with 5cc normal saline

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 5mg/kg over 20-60min
    • Procainamide 15mg/kg over 30-60min

See Also

• PALS (Main)
• ACLS: Tachycardia
• SVT
• Critical care quick reference

References

AHA 2010 Guidelines for PALS