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Identify the following rhythms 1.  2. 3.  4. 5. Answers 1. Accelerated Junctional rhythm  The rhythm is slightly irregular with a rate of 80/min.   There are no P waves before each QRS complex.   There is one ectopic beat, the 7th complex which has a small inverted P wave before the QRS complex.  Based upon the rate and the absence of P waves this is an accelerated junctional rhythm.  PR;  ---,  QRS:  .08 sec,  QT:  .48 sec. 2. Biventricular pacing The rhythm is regular with a ventricular rate of 75/min. Although there is artifact, there are some upright P waves seen between some of the QRS complexes.  The PR interval on these beats is prolonged.  Biventricular pacer spikes precede each QRS complex.   The QRS complex is primarily negative with a positive ST segment.   This is characteristic of a ventricular paced rhythm.  PR:  .32 sec...

I ntervene Electrically: Synchronized Cardioversion ·          Specific timed delivery of electrical shock to the heart ·          Treatment of choice for SVT, VT with a pulse and atrial flutter with evidence of poor profusion ·          Initial energy level is 0.5-1J/kg ·          May be increased to 1-2J/kg on second attempt ·          Provide sedation and analgesia Note:  In synchronized cardioversion, energy delivery is synchronized (occurs simultaneous with the QRS) with the ECG so that impulses are not delivered during the ventricle’s relative refractory period, as this could cause ventricular fibrillation. Synchronized cardioversion is indicated when a child who has a pulse shows signs of unstable supraventricular tachycardia or unstable ventricular tachycardia. Cardioversion ...

A denosine ·          Drug of choice for treatment of SVT ·          Blocks conduction through the AV node ·          Continuous ECG monitor ·          Give 0.1mg/kg- max initial dose 6mg ·          Very short half life ·          Use rapid flush technique ·          May double dose if ineffective Note: If vascular access is immediately available, rapidly administer 0.1 mg/kg adenosine via IV or IO, immediately followed by a rapid flush of at least 5 mL saline. If there is no response, repeat the dose at 0.2 mg/kg to a maximum individual dose of 12 mg, using the same technique. In any patient who exhibits SVT, obtain recordings of the cardiac rhythm before, during, and after interventions. Note:  Side ef...

V agal Maneuvers ·          May be attempted while waiting for cardioversion ·          Success depends upon the patient’s age and ability to cooperate ·          Increase parasympathetic tone thereby decreasing the patient’s heart rate Note:  Carotid massage is usually ineffective in children; if it is attempted, it should be performed on only 1 side of the neck. Applying ocular pressure is contraindicated in all cases due to the risk of retinal detachment. Vagal Maneuvers ·          Ice water application to the face ·         Older c hildren may blow through a straw ·          Coughing ·          Valsalva maneuvers Valsalva maneuver ·          Document the dysrhythmia before treati...

E valuate Rhythm ·          Obtain 12 lead EKG ·          Determine if QRS complex is ≥0.12 second ·          Determine treatment options. Note :  Stable patients may await expert consultation because treatment has the potential for harm Narrow Complex Tachycardias ·          Atrial flutter ·          AV nodal reentry ·          Accessory pathway–mediated tachycardia ·          Atrial tachycardia (including automatic and reentry forms) ·          Multifocal atrial tachycardia (MAT) ·          Junctional tachycardia (rare in adults) Note :  Irregular narrow-complex tachycardias are likely MAT or a variable atrial flutte...

Mnemonic for Treating SVT ·          P rimary Survey ·          R ecognize symptoms of instability ·          E valuate rhythm- EKG ·          V agal Maneuvers ·          A denosine ·          I ntervene electrically ·          L ook to the Experts P rimary Survey ·          Airway- supplemental oxygen ·          Breathing ·          Circulation ·          Check VS ·          Assess pulse ·          Attach defibrillator/monitor ·        ...

"Too Fast" rhythms ·          Sinus tachycardia ·          Supraventricular tachycardia ·          Ventricular tachycardia (with pulse) ·          Wide complex tachycardia Note:  Just before the onset of pediatric cardiopulmonary failure, children may exhibit tachypnea and tachycardia, compensatory mechanisms that attempt to increase cardiac output and decrease acidosis. In most cases, blood pressure remains normal until cardiopulmonary failure is imminent. As oxygen demand increases and the child tires, compensatory mechanisms fail. The heart and respiratory rate decrease and blood pressure drops, signifying the onset of cardiopulmonary failure. Outcome is best if the child’s condition is recognized and treated aggressively before this point. Treatment Approach ·          Need for ...