When a child’s heart starts racing faster than it should, it can be a real emergency, and knowing what to do in those critical moments can make all the difference. Tachycardia simply means a faster-than-normal heart rate, but in pediatric patients, what’s considered “too fast” depends on the child’s age.
For instance, what’s a normal heart rate for a newborn would be way too fast for a teenager. That’s why the PALS Tachycardia Algorithm is so essential. It gives healthcare providers a clear, step-by-step guide to manage these crises quickly and effectively. This algorithm isn’t just for doctors, it’s designed for the entire pediatric care team, from nurses to paramedics, to work together seamlessly when every second counts.
In this guide, we’ll break down what tachycardia means for kids, review normal heart rate ranges by age, and explain how the PALS Tachycardia Algorithm helps save lives when a child’s heart needs urgent help.
Curious about how a child’s normal heart rate compares to the faster heartbeat seen in tachycardia? Let’s explore what these differences mean for kids’ health and well-being.
|
Age Group |
Normal Heart Rate (bpm) |
Tachycardia (bpm) |
|
Infants (1-12 Months) |
80-160 bpm |
160+ bpm |
|
Toddlers (1-2 Years) |
80-130 bpm |
130+ bpm |
|
Preschool (3-5 Years) |
80-120 bpm |
120+ bpm |
|
School Age ( 6-11+ Years) |
70-120 bpm |
120+ bpm |
Tachycardia in children can be caused by a variety of reasons, from common factors like fever and dehydration to more complex issues like structural heart problems or arrhythmias. It is crucial to identify it quickly to save the life of a pediatric patient.
|
Category |
Examples |
|
Physiological |
Fever, anxiety, dehydration, or pain |
|
Structural Heart Disease |
Congenital heart defects or cardiomyopathies |
|
Infections |
Myocarditis, sepsis, or other systemic infections |
|
Electrolyte Imbalances |
Hypokalemia, hypomagnesemia |
|
Medications and Toxins |
Stimulants, caffeine, or certain drugs |
|
Autonomic Nervous System Factors |
Stress or sympathetic stimulation |
Dealing with tachycardia with a pulse can be tough, but understanding the pediatric tachycardia algorithm makes it more manageable. Let’s walk through the steps together so you understand what to do when every second counts.
01.
The first step in managing a pediatric tachycardia is rapid assessment and stabilization. Ensure a clear airway, assist breathing if needed, and administer oxygen. Connect the patient to a cardiac monitor to identify the rhythm, and monitor pulse, blood pressure, and oxygen levels closely. Establish IV or IO access early for medication or fluid administration. If available, obtain a 12-lead ECG to better evaluate the heart’s activity.
02.
Once the initial support is in place, the next step is to evaluate the pediatric heart rhythm using a monitor or a 12-lead ECG if you have one available. Take a close look at the rhythm. If it appears to be probable sinus tachycardia, you’ll move on to Step 3 for further evaluation and management. However, if the rhythm suggests that the pediatric patient is experiencing signs of cardiopulmonary compromise, it’s critical to skip ahead and go directly to Step 5, where more advanced interventions are needed.
03.
You're looking for signs that the rhythm is consistent with probable sinus tachycardia. For a pediatric patient, that means the P waves should be present and appear normal, and the R-R intervals can vary. In terms of heart rate, an infant typically has a rate less than 220 bpm, while a child usually has a rate under 180 bpm. If all these findings line up, you can move on to Step 4 for further assessment and care.
04.
Your focus shifts to finding out what’s causing the tachycardia and addressing it directly. In pediatric cases, common causes can include pain, hypoxia, fever, dehydration, or anxiety. Take a good look at the overall clinical picture, check for signs of infection, evaluate the fluid level, ensure the child is getting enough oxygen, and manage any discomfort or stress. The goal here is to treat the underlying issue rather than the heart rate itself, since tachycardia is usually a response to something else going on in the body.
05.
It's time to determine whether the patient is showing signs of cardiopulmonary compromise. Look for key indicators like an acutely altered mental status, signs of shock (such as cool extremities, delayed capillary refill, or weak pulses), and hypotension. These signs suggest that the heart isn't effectively supporting circulation. If any of these red flags are present, move immediately to Step 6 for urgent intervention. If none are present, and the child appears more stable, you can skip ahead to Step 11 for continued evaluation and care.
06.
It's all about evaluating the QRS duration on the ECG to help narrow down the type of tachycardia you're dealing with. Take a close look at the width of the QRS complex. If it’s narrow, meaning 0.09 seconds or less, then you’ll move on to Step 7, which focuses on managing narrow-complex tachycardia. However, if the QRS is wide, greater than 0.09 seconds, that points to a different mechanism, and you should skip ahead to Step 9 for appropriate treatment of wide-complex tachycardia.
07.
You're assessing for probable supraventricular tachycardia (SVT), especially in the context of a narrow QRS complex. Key signs to look for include absent or abnormal P waves and an RR interval that stays consistent, rather than varying. In terms of heart rate, an infant generally has a rate of 220 bpm or higher, while a child usually presents with a rate of 180 bpm or higher. A helpful clue is a history of sudden onset; SVT often starts and stops abruptly. If all these signs point to SVT, go ahead and move on to Step 8 for management.
08.
The next action is to establish IV/IO access if you haven’t already. If access is available, you’ll administer adenosine to help break the supraventricular tachycardia. Adenosine works by temporarily blocking the electrical signals in the heart, which can reset the rhythm. However, if IV/IO access isn’t available or if adenosine doesn’t work to restore normal rhythm, the next step is to perform synchronized cardioversion. This procedure involves delivering a controlled shock to the heart to reset its rhythm and bring it back to normal.
09.
You’re considering the possibility of ventricular tachycardia (VT), which generally presents with a wide QRS complex. If you suspect VT, it's crucial to move quickly to Step 10 for further evaluation and treatment, as this rhythm can be life-threatening and requires immediate intervention.
10.
If ventricular tachycardia (VT) is confirmed or highly suspected, synchronized cardioversion is the next step to restore normal rhythm. This procedure involves delivering a steady shock to the heart while it’s in the right phase of the cardiac cycle. It’s important to consult with an expert before considering additional drug therapies, as VT is a serious condition, and further treatments need to be tailored to the specific situation based on expert guidance.
11.
You need to evaluate the QRS duration once again. If the QRS complex is narrow (0.09 seconds or less), you’ll proceed to Step 12 for further management of the tachycardia. On the other hand, if the QRS is wide (greater than 0.09 seconds), it’s time to skip ahead to Step 15 for a different approach to treatment.
12.
You’re once again assessing for probable supraventricular tachycardia (SVT), particularly with a narrow QRS complex. Look for signs like absent or abnormal P waves, and a consistent RR interval (not varying). In infants, the heart rate is usually 220 bpm or higher, while in children, it’s typically 180 bpm or more. A key clue is a history of a sudden onset or abrupt rate change, which is common with SVT. If these signs point to SVT, proceed to Step 13 for further management.
13.
You should consider using vagal maneuvers as an initial, non-invasive way to treat supraventricular tachycardia (SVT) in a stable pediatric patient. These techniques, such as an ice pack to the face for infants or having an older child blow through a straw, can stimulate the vagus nerve and help slow down the heart rate. If the vagal maneuvers are ineffective or not appropriate, you'll move on to Step 14 for the next line of treatment.
14.
If IV/IO access is available, administer adenosine to treat the suspected supraventricular tachycardia. Adenosine works by briefly blocking conduction through the AV node, which can interrupt the abnormal rhythm and restore normal sinus rhythm. It’s most effective when given as a rapid IV push, followed instantly by a flush. Be sure to observe the patient closely during and after administration.
15.
It is based on the presence of a wide QRS complex, you're now considering possible ventricular tachycardia (VT). This rhythm can be serious, even if the patient seems stable, so it’s important to act quickly. Move ahead to Step 16 for evaluation and proper management.
16.
You should consider using vagal maneuvers as an initial, non-invasive way to treat supraventricular tachycardia (SVT) in a stable pediatric patient. These techniques, such as an ice pack to the face for infants or having an older child blow through a straw, can stimulate the vagus nerve and help slow down the heart rate. If the vagal maneuvers are ineffective or not appropriate, you'll move on to Step 14 for the next line of treatment.
17.
It’s time to bring in additional support, expert consultation is strongly recommended. Ventricular tachycardia, especially when continuous or unclear in origin, can be difficult to manage and need advanced interventions or individualized therapies. Consulting a pediatric cardiologist or other capable specialist ensures the patient receives the safest and most effective care moving forward.
In short, PALS Algorithm for tachycardia depends on staying calm, thinking critically, and acting swiftly. Recognize early signs, comprehend your steps, and trust your training, whether managing narrow or wide complex tachycardia. Regular practice and a solid understanding of the concepts help you act confidently in high-pressure moments. Remember, the flowchart is a tool to guide safe, timely, and life-saving care. Ready to improve your skills? Enroll in a PALS certification course with BaysideCPR and boost your confidence in emergencies!
Child: ST is usually < 180 bpm; SVT is usually > 180 bpm
