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Pediatrics
ObjectivesObjectives
• Approach to critical dysrhythmias
• Review normal conduction system
• Review common pediatric dysrhythmias
• Management of critical dysrhythmias
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Pediatrics
How do you approach an EKG?How do you approach an EKG?
• Rate: Atrial, ventricular
• Rhythm
• Axis
• Waves: P wave, QRS complex, T wave
• Intervals: PR, ST, QT
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Pediatrics
But… what if you see this on theBut… what if you see this on the
monitor??monitor??
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Pediatrics
Approach to dysrhythmiasApproach to dysrhythmias
• Pulse? conscious?
• Narrow or wide?
• P wave?
• Regular or Irregular?
• Slow or fast?
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SA node: rhythm generator Membrane action potential has characteristic pattern: RMP -60, slow upstroke in phase 1, no plateau phase and spont depol in phase 4 Travel across the the normal system results in characteristic pattern on EKG of atrial depolarization, AV delay, ventricular depol and vent repol EKG displays positive forces when the direction of depol is directed towards the lead recording it: hence P wave upright in lead 1 and avF when rhythm generated by sinus node. xxx00.#####.ppt 07/05/13 P.
Reentry (SVT): common, 2 conducting pathways fast and slow with long and short refractory periods, Premature complex may get blocked by the long refractory period path paroxysmal, abrupt onset, no variability, cardioversion or AV blockade (adenosine): effective Automaticity/ Ectopic focus (JET): Ability of the cell to trigger the rhythm: usually SA nodes job, but any cell in the conduction system or cardiac tissue (focus) can take over: has features like sinus tachy: slow on/off, responsive to metabolic states, variability, no response to cardioversion or AV blockade Triggered activity (digoxin toxicity, long QT): rare, has features of both above, results from after depol: abrupt change in membrane potential during action potential xxx00.#####.ppt 07/05/13 P.
1 st prolongation of PR Mobitz 1: wenckebach: serial prolongation of PR with successive beats lost beat Mobitz 2: blocked Ps, 2:1, 3:1 xxx00.#####.ppt 07/05/13 P.
Because picture is worth a 1000 words PAC: may get conducted or may get blocked, aberrant conduction may cause wide QRS AET: abnormal focus, multiple foci, may or may not get conducted xxx00.#####.ppt 07/05/13 P.
12 lead EKG, electrolytes, blood gas (Hs/Ts) xxx00.#####.ppt 07/05/13 P.