PALS: Tachycardia

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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)

Source

2010 PALS Guidelines