PALS Megacode Scenario Simulations on Tachycardia

In this practice paper healthcare providers will be given scenarios to identify the type of tachycardia and implement the correct interventions based on PALS protocols. Participants will refine their skills in rapid assessment, medication administration, and synchronized cardioversion. This resource is ideal for both medical and non-medical professionals.

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1

What underlying cause should be considered before focusing on tachycardia treatment?

A 5-year-old patient presents with a heart rate of 190 bpm and mild chest discomfort. ECG reveals a narrow-complex tachycardia. The child has a history of recent viral illness.

Hint: Consider conditions that can increase the heart rate as a response to an underlying illness.
2

What is the other clinical feature important to assess immediately?

An 8-year-old girl collapses while playing soccer. Upon EMS arrival, her pulse is 220 bpm, and she is unresponsive. The monitor shows a narrow-complex tachycardia.

Hint: You are looking for signs of hemodynamic instability.
3

Which of the following laboratory results would be most helpful in determining the cause of the arrhythmia?

During a PALS megacode, you are managing a 7-year-old patient with wide-complex tachycardia. The child is conscious but pale and diaphoretic. The monitor shows ventricular tachycardia.

Hint: What electrolyte plays a direct role in the function of the cardiac conduction system?
4

Which of the following is NOT a possible trigger for his tachycardia?

A 3-year-old boy presents to the ER with irritability and tachycardia of 180 bpm. He is febrile, and his ECG shows a narrow-complex tachycardia. His mother mentions that he has been receiving albuterol treatments for asthma.

Hint: One of these options is a known side effect of a common asthma medication.
5

Which cardiac rhythm is the patient most likely in?

You are treating a 9-year-old patient who was brought in after fainting at school. The ECG shows a regular wide-complex tachycardia at 190 bpm. The child is pale but responsive. The parents mention a family history of cardiac issues.

Hint: SVT stands for Supraventricular Tachycardia, a medical condition that has an abnormally fast heart rhythm (tachycardia). This originates above the ventricles in the heart's upper chambers (the atria).
6

What precaution should you take when administering adenosine?

A 2-year-old presents with lethargy and a heart rate of 240 bpm. The monitor shows supraventricular tachycardia (SVT). The child is non-responsive to vagal maneuvers, and you are preparing to administer adenosine.

Hint: Adenosine should always be given via rapid IV infusion followed by a saline flush.
7

Which of the following is the most likely electrolyte abnormality in this case?

A 12-year-old boy is brought in after a syncopal episode during gym class. The ECG shows polymorphic ventricular tachycardia (Torsades de Pointes). He is awake but complaining of dizziness.

Hint: A common characteristic of hypocalcemia is a prolonged QT interval on an ECG, not Torsades de Pointes.
8

What complication should you monitor for in this case?

You are caring for a 6-year-old with tachycardia in the PICU. The child is post-operative from a major surgery and has an underlying heart condition. Her ECG shows an atrial fibrillation at 180 bpm.

Hint: Atrial arrhythmias can cause blood to pool in certain parts of the heart.
9

What underlying condition might make pharmacological treatment more difficult?

A 6-year-old boy with a structurally normal heart presents to the ER with a regular, narrow-complex tachycardia at a rate of 180 bpm. He is stable, but vagal maneuvers and adenosine have not converted the rhythm.

Hint: This condition is also one of the most common causes of tachycardia in the pediatric population.
10

What should be the next course of action?

A 4-year-old with a congenital heart defect presents with narrow-complex tachycardia. The child is pale, lethargic, and has a heart rate of 210 bpm. After administering two doses of  adenosine, the child briefly converts to sinus rhythm but quickly reverts to tachycardia.

Hint: Vagal maneuvers is an intervention that should be taken before administration of adenosine.

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