🧒 PALS Pediatric Tachycardia Management
This tool applies the AHA PALS tachycardia algorithm, choosing between synchronized cardioversion, adenosine and antiarrhythmics by hemodynamic stability and QRS width, with weight-based doses.
SVT is distinguished from sinus tachycardia by rate (infants often > 220, children > 180), absent rate variability and abnormal/absent P waves; sinus tachycardia is treated by addressing the cause.
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When to use
Use in a child with tachycardia to determine management by stability and QRS width and calculate cardioversion energy and drug doses.
How it works
Unstable (with a pulse) → synchronized cardioversion 0.5–1 J/kg → 2 J/kg. Stable narrow QRS (SVT) → vagal maneuvers → adenosine 0.1 mg/kg (max 6) → 0.2 mg/kg (max 12). Stable wide QRS (suspected VT) → expert consultation, amiodarone 5 mg/kg or procainamide 15 mg/kg.
Key points
- SVT is distinguished from sinus tachycardia by rate (infants often > 220, children > 180), absent rate variability and abnormal/absent P waves; sinus tachycardia is treated by addressing the cause.
- In unstable tachycardia, sedation should not delay synchronized cardioversion; adenosine may be tried only if it does not delay shock.
- Amiodarone and procainamide must not be combined for wide-complex tachycardia because of the risk of severe hypotension; expert consultation is advised.
References
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Weight (to calculate doses) | 15 kg |
|---|---|
| Hemodynamics | Unstable (hypotension/altered mental status/shock) |
| QRS width | Narrow QRS (≤ 0.09 s, mostly SVT/sinus tachycardia) |
→ManagementSynchronized cardioversion
- Management：Unstable (with a pulse) → immediate synchronized cardioversion: 0.5–1 J/kg = 7.5–15 J, escalate to 2 J/kg = 30 J if ineffective (sedation should not delay cardioversion)
- May concurrently：If access is established and it will not delay cardioversion, narrow-regular QRS may try adenosine 0.1 mg/kg = 1.5 mg first
- Basis：AHA PALS tachycardia with a pulse and poor perfusion algorithm
| Weight (to calculate doses) | 15 kg |
|---|---|
| Hemodynamics | Stable |
| QRS width | Wide QRS (> 0.09 s, suspected VT) |
→ManagementAmiodarone/procainamide
- Management：Wide QRS (suspected VT), stable → expert consultation; amiodarone 5 mg/kg = 75 mg IV (over 20–60 min) OR procainamide 15 mg/kg = 225 mg IV (over 30–60 min), do not combine the two (causes severe hypotension)
- Adenosine：Only if wide QRS is regular and monomorphic may consider adenosine 1.5 mg
- If unstable：Synchronized cardioversion 0.5–1 J/kg = 7.5–15 J → 2 J/kg = 30 J
Frequently asked questions
- What is PALS Pediatric Tachycardia Management?
- This tool applies the AHA PALS tachycardia algorithm, choosing between synchronized cardioversion, adenosine and antiarrhythmics by hemodynamic stability and QRS width, with weight-based doses.
- How is PALS Pediatric Tachycardia Management calculated? What is the core formula?
- Unstable (with a pulse) → synchronized cardioversion 0.5–1 J/kg → 2 J/kg. Stable narrow QRS (SVT) → vagal maneuvers → adenosine 0.1 mg/kg (max 6) → 0.2 mg/kg (max 12). Stable wide QRS (suspected VT) → expert consultation, amiodarone 5 mg/kg or procainamide 15 mg/kg.
- When is PALS Pediatric Tachycardia Management used?
- Use in a child with tachycardia to determine management by stability and QRS width and calculate cardioversion energy and drug doses.
- What are the key clinical points for PALS Pediatric Tachycardia Management?
- SVT is distinguished from sinus tachycardia by rate (infants often > 220, children > 180), absent rate variability and abnormal/absent P waves; sinus tachycardia is treated by addressing the cause. In unstable tachycardia, sedation should not delay synchronized cardioversion; adenosine may be tried only if it does not delay shock. Amiodarone and procainamide must not be combined for wide-complex tachycardia because of the risk of severe hypotension; expert consultation is advised.
- What are the limits and cautions when using PALS Pediatric Tachycardia Management?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- How is PALS Pediatric Tachycardia Management calculated in practice? Can you show a worked example?
- Inputs: Weight (to calculate doses) 15 kg, Hemodynamics Unstable (hypotension/altered mental status/shock), QRS width Narrow QRS (≤ 0.09 s, mostly SVT/sinus tachycardia) → Result: Management Synchronized cardioversion（Management: Unstable (with a pulse) → immediate synchronized cardioversion: 0.5–1 J/kg = 7.5–15 J, escalate to 2 J/kg = 30 J if ineffective (sedation should not delay cardioversion), May concurrently: If access is established and it will not delay cardioversion, narrow-regular QRS may try adenosine 0.1 mg/kg = 1.5 mg first, Basis: AHA PALS tachycardia with a pulse and poor perfusion algorithm） Inputs: Weight (to calculate doses) 15 kg, Hemodynamics Stable, QRS width Wide QRS (> 0.09 s, suspected VT) → Result: Management Amiodarone/procainamide（Management: Wide QRS (suspected VT), stable → expert consultation; amiodarone 5 mg/kg = 75 mg IV (over 20–60 min) OR procainamide 15 mg/kg = 225 mg IV (over 30–60 min), do not combine the two (causes severe hypotension), Adenosine: Only if wide QRS is regular and monomorphic may consider adenosine 1.5 mg, If unstable: Synchronized cardioversion 0.5–1 J/kg = 7.5–15 J → 2 J/kg = 30 J）