🧒 PALS Pediatric Tachycardia Management
UseUse in a child with tachycardia and a pulse: step-by-step management by stability and QRS width.
Source2025 AHA/AAP Pediatric Advanced Life Support guidelines (Part 8, PMID 41122885)
This-shift next steps
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Methodology · worked example, guidelines & full notes
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.
When to use
Use in a child with tachycardia and a pulse: step-by-step management by stability and QRS width.
How it works
Unstable (with a pulse) → synchronized cardioversion. Stable narrow QRS (SVT) → vagal maneuvers → adenosine. Stable wide QRS (suspected VT) → expert consultation, amiodarone or procainamide.
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
- [Guideline / primary source]2025 AHA/AAP Pediatric Advanced Life Support guidelines (Part 8, PMID 41122885)
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 | 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; energy per current PALS and local protocol. Sedation should not delay cardioversion.
- May concurrently：If access is established and it will not delay cardioversion, narrow-regular QRS may try adenosine first
- Basis：AHA PALS tachycardia with a pulse and poor perfusion algorithm
| Weight | 15 kg |
|---|---|
| Hemodynamics | Stable |
| QRS width | Wide QRS (> 0.09 s, suspected VT) |
→ManagementAmiodarone/procainamide
- Management：Wide QRS (suspected VT), stable → expert consultation; amiodarone OR procainamide as a slow IV infusion, do not combine the two (causes severe hypotension)
- Adenosine：Only if wide QRS is regular and monomorphic may consider adenosine
- If unstable：If the child becomes unstable, synchronized cardioversion; energy per current PALS and local protocol.
Verification & sources · governance
FAQ
Frequently asked questions
- 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.
- Does PALS Pediatric Tachycardia Management upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
- How is PALS Pediatric Tachycardia Management calculated in practice? Can you show a worked example?
- Inputs: Weight 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; energy per current PALS and local protocol. Sedation should not delay cardioversion., May concurrently: If access is established and it will not delay cardioversion, narrow-regular QRS may try adenosine first, Basis: AHA PALS tachycardia with a pulse and poor perfusion algorithm） Inputs: Weight 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 OR procainamide as a slow IV infusion, do not combine the two (causes severe hypotension), Adenosine: Only if wide QRS is regular and monomorphic may consider adenosine, If unstable: If the child becomes unstable, synchronized cardioversion; energy per current PALS and local protocol.）