This document provides guidance on evaluating and managing tachyarrhythmia in children. It outlines assessing for a pulse and stability, then determining if the rhythm is wide or narrow complex. Narrow complex tachycardias could be supraventricular tachycardia (SVT), characterized by abrupt onset and no P waves, or sinus tachycardia, with a gradual onset that varies with activity and visible P waves. Management of SVT includes vagal maneuvers, adenosine or amiodarone medication, and electrical cardioversion if needed. The cause should also be considered.

1. Tachyarrhythmia
Approach to management:
1. Determine if there is a pulse
– If no pulse, initiate management for pulseless
arrest
2. Determine if patient is stable
3. Determine if it is a wide complex or narrow
complex tachycardia

2. Narrow Complex Tachycardia
Supraventricular Tachycardia
• Abrupt onset
• In infants, rate ≥ 220
beats/min
• In older children, rate ≥ 180
beats/min
• No P waves
• No beat to beat variability
Sinus Tachycardia
• Gradual onset, varies with
activity
• In infants, rate < 220
beats/min
• In older children, rate < 180
beats/ min
• P waves visible

3. PALS Tachycardia Algorithm.
Kleinman M E et al. Circulation 2010;122:S876-S908
Copyright © American Heart Association

4. Management of SVT
• Vagal manoeuvres
• Pharmacologic
– Adenosine 0.1mg/kg rapid IV push
– Amiodarone
• Electrical cardioversion
– Synchronised
– 0.5-1 J/kg, may increase to 2J/kg
• Consider causes