Feature | Cardiovascular Education | May 02, 2019| Judy Haluka, RCIS, EMT

The Basics of the Pediatric Tachycardia for Pediatric Advanced Life Support

A quick guide to PALS pediatric tachycardia guidelines

This is the AHA pediatric tachycardia PALS algorithm flow sheet.

This is the AHA pediatric tachycardia PALS algorithm flow sheet. Download a copy of this at www.acls.net/images/algo-pals-Tachycardia.pdf.

The treatment of all patients in distress with significant symptoms begins with the basics, and pediatric tachycardia is no different. Here is the outline of the American Heart Association (AHA) Pediatric Advanced Life Support (PALS) guidelines.

First Steps:

   • Oxygen if indicated by pulse oximetry less than 95% or shortness of breath.
   • Maintain airway.
   • Place the patient on the cardiac monitor.
   • Monitor vital signs, including oximetry.
   • IV or IO access.
   • 12 Lead ECG to assist with diagnosis if the condition of the patient permits (do not delay emergent treatment).
   • The treatment of tachycardia is based on the type of tachycardia.  

 

Identify The Type of Tachycardia

There are three possible types. Narrow complex tachycardia, which is further divided into sinus tachycardia and supraventricular tachycardia, and wide complex tachycardia, which might be a possible ventricular tachycardia.

Narrow complex tachycardia must have a QRS duration less than 0.1 seconds.

 

Sinus Tachycardia:

   • Diagnosis is often based upon history.  This patient will have a history consistent with a known cause that requires compensation.  For example, dehydration, pain, hypovolemia.
   • P waves are normal, rhythm is regular and rate is usually less than 220  per minute in infants and 180 in children.

TREATMENT: Find and treat the underlying cause. For example, in dehydration replace fluid; treat pain, etc.

 

Supraventricular Tachycardia:

   • History is vague.
   • P waves are absent or abnormal looking, heart rate is usually greater than 220 in infants and greater than 180 in children.

Treatment: If IV or IO is available, give adenosine 0.1 mg/kg rapid bolus (maximum of 6 mg)  This can be repeated with a second dose of 0.2 mg/kg rapid bolus (maximum of 12 mg).
 
If adenosine is unsuccessful, or IV/IO access is not available synchronized cardioversion is indicated. 
   • Start at 0.5-1.0 joules/kg — if not effective increase to 2 joules/kg.
   • Sedate if needed, but do not delay treatment.

 

Wide Complex Tachycardia (QRS >0.09 secs) — Probable Ventricular Tachycardia:

Always begin with the basics. 
   • If the child is hypotensive, has acute altered level of consciousness, or signs of shock, Immediate synchronized cardioversion is indicated.
     - 0.5 joules/kg
     - 2 joules/kg
• If no hypotension, altered level, or signs of shock, and the rhythm is regular with monomorphic (all QRSs look alike) consider using adenosine.
     - Adenosine 0.1 mg/kg rapid IV bolus maximum of 6 mg.
     - Adenosine 0.2 mg/kg rapid IV bolus maximum of 12 mg.
• If no hypotension, altered level or signs of shock consult an expert (cardiology or electrophysiology) who will consider:
     - Amiodarone 5 mg/kg IV/IO over 20-60 minutes, or
     - Procainamide IO/IV 15 mg over 30-60 minutes.
     - However, these should not be administered together.

The information in this article provided by from the ACLS Training Center is current with respect to 2015 AHA Guidelines for CPR and ECC. These guidelines are current until their expected update in October 2020.

 

Download a PDF version the pediatric tachycardia algorithm.

 

Editor's note: The author Judy Haluka, RCIS, EMT, started her career at a tertiary hospital in the cardiac catheterization laboratory following receipt of her bachelor’s in biology/cardiac sciences in the early 1980’s. She is credentialed as a registered cardiovascular invasive specialist through Cardiovascular Credentialing International. She is further credentialed as an emergency medical technician – paramedic through the Pennsylvania Department of Health.

Related Content

U.S. Soldiers Have Worse Heart Health Than Civilians
News | Cardiac Diagnostics | June 06, 2019
Active duty Army personnel have worse cardiovascular health compared to people of similar ages in the civilian...
Late Dinner and No Breakfast Worsens Outcomes After Heart Attack
News | Cardiac Diagnostics | May 23, 2019
People who skip breakfast and eat dinner near bedtime have worse outcomes after a heart attack, according to research...
HRS Releases New Expert Consensus Statement on Arrhythmogenic Cardiomyopathy
News | Cardiac Diagnostics | May 14, 2019
The Heart Rhythm Society (HRS) released a first-of-its-kind consensus statement with guidance on the evaluation and...
New Best Practices Help Manage Heart Attack Patients Without Significant Signs
News | Cardiac Diagnostics | April 15, 2019
For the first time in the United States, doctors with the American Heart Association (AHA) have outlined best practices...
The most recent U.S. Food and Drug Administration (FDA) clearance was Siemens Healthineers high-sensitivity troponin I assays (TnIH) for the Atellica IM and ADVIA Centaur XP/XPT in vitro diagnostic analyzers. The test helps in the early diagnosis of myocardial infarctions without the need for serial tropic testing. The time to first results is 10 minutes.

The most recent U.S. Food and Drug Administration (FDA) clearance was Siemens Healthineers high-sensitivity troponin I assays (TnIH) for the Atellica IM and ADVIA Centaur XP/XPT in vitro diagnostic analyzers. The test helps in the early diagnosis of myocardial infarctions without the need for serial tropic testing. The time to first results is 10 minutes. 

Feature | Cardiac Diagnostics | March 22, 2019 | Linda C. Rogers, Ph.D.
Troponins are a family of proteins found in skeletal and heart (cardiac) muscle fibers that produce muscular contract
ACC/AHA Update Guidance for Preventing Heart Disease; Stroke
Feature | Cardiac Diagnostics | March 18, 2019
The choices we make every day can have a lasting effect on our heart and vascular health. Adopting a heart healthy...
AHA Statement Warns Hookah Smoking May Harm the Heart
News | Cardiac Diagnostics | March 08, 2019
Smoking tobacco in waterpipes, more commonly known as hookahs, results in inhaling toxic chemicals, often at levels...
PTSD Alone Does Not Increase Heart Disease Risk in Veterans
News | Cardiac Diagnostics | February 20, 2019
February 20, 2019 — Post-traumatic stress disorder (PTSD) by itself does not explain the...
Hormone Therapy May Increase Cardiovascular Risk During Gender Transition
News | Cardiac Diagnostics | February 18, 2019
Patients receiving hormone therapy as part of their gender-transition treatment had an elevated risk for cardiovascular...
Overlay Init