RQI Pediatric Advanced Life Support (PALS) Practice Test

A wide QRS tachycardia in a child is most often ventricular tachycardia, so the priority is to assess stability and treat accordingly. If the child is unstable, you perform synchronized cardioversion immediately; this delivers immediate, controlled electrical energy to restore a perfusing rhythm. If the child is stable, an antiarrhythmic that can terminate VT is appropriate, and amiodarone is a good first choice because it works across multiple channels and is effective for VT with a relatively favorable safety profile in children. The typical approach is an IV bolus of about 5 mg/kg, which can be repeated once up to a total of roughly 15 mg/kg if VT persists, followed by a maintenance infusion per protocol. Amiodarone helps suppress the abnormal electrical activity and can convert the rhythm without the abrupt hemodynamic changes that may accompany immediate shock. If amiodarone fails or is contraindicated, other antiarrhythmics like procainamide can be considered, or you proceed with synchronized cardioversion if the patient becomes unstable.