🧒 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.
PALS Pediatric Tachycardia Management
Weight (to calculate doses) (kg)
Hemodynamics
QRS width
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
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.