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103 Cards in this Set
- Front
- Back
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Ventricular tachycardia (monomorphic)
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Sustained series of wide QRS complexes (ie ventricular depolarizations) at a rate of at least 120/min
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Monomorphic
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all complexes have the same apperance
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Clinical clue
HR = 214/min |
Wide complex tachycardia; presumed ventricular tachycardia
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Clinical cue
HR = 44/min; no detectable pulses |
Pulseless electrical activity (PEA)
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PEA (pulseless electrical activity)
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Cardiac arrest rhythms
Idioventricular escape rhythm; characterized by wide QRS complexes |
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Clinical cue
8 yo ; HR= 50/min |
Sinus bradycardia
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Sinus bradycardia characterized by:
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sinus rhythm with a rate that is slower than normal for age. P waves and QRS complexes are usually normal...QRS is narrow
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Clinical cue:
no detectable pulses |
Asystole
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Asystole is
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absence of ventricular depolarization ; may be preceded by an agonal (usually wide complex)
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Clinical cue:
no consistent heart rate; no detectable pulses |
Ventricular fibrillation
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Ventricular fibrillation characterized by:
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rapid, irregular waveform. If no CPR and no shocks are given, this will progress to asystole
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Clinical cue:
3 yo ; HR = 188/min |
Sinus tachycardia
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Sinus tachycardia is characterized by:
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normal sequence of impulse formation and conduction with a rate faster than normal for age. P waves precede QRS complex; QRS is narrow
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Clinical clue:
HR = 300/min |
supraventricular tachycardia
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supraventricular tachycardia is characterized by:
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no beat to beat variability with activity or stimulation
HR more than 220/min in infants and more than 180/min in children absent or abn. P waves; narrow QRS complexes |
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Clinical cue:
8 yo ; HR = 75/min |
normal sinus rhythm
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Clinical cue:
Initial rhythm associated with no detectable pulses |
Ventricular fibrillation converted to organized rhythm after succussful shock therapy
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Clinical cue;
9 months old; HR 38/min |
sinus bradycardia with first-degree AV block
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Sinus bradycardia with first degree AV block is characterized by:
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Atrial depolarization (p wave) before each QRS complex, but the rate is less than 60/min
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Clinical cue;
HR - 200/min; no detectable pulses |
Torsades de pointes (polymorphic ventricular tachycardia)
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Torsades de pointes is characterized by:
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QRS complexes that change in amplitude and polarity in a cyclic pattern . Ventricular rate range from 150 to 250/ min
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clinical cue:
HR = 150/min |
wide complex tachycardia
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clinical cue:
initial rhythm associated with HR = 300/min |
Supraventicular tachycardia converting to sinus rhythm with adenosine administration
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Treatment?
Infant with severe symptomatic bradycardia associated with resp. distress. Which is the first drug? |
Epinephrine
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What is epinephrine?
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a catecholamine with direct effects at the beta adrenergic recepter
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What does epi do?
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improves HR in a hypoic-ishemic myocardium
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When to use atropine?
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if bradycardia is vagally induced or associated with heart block.
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Epi improves
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coronary artery perfusion pressure and myocardial oxygen
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What delivers a high (90%) concentration of oxygen in a toddler or older child?
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Nonbreathing face mask with 12L/min oxygen flow
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High flow O2
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more than 10 L / min. tight fitting - non breathing mask with reservoir
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Low flow O2
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Less than 10 L /min. patient inspiratory flow exceeds O2 flow
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Max nasal cannula flow
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4 L / min
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OPA
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only for unconscioius victim without gag reflex
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NPA
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for conscious or semi conscious victim
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Measuring OPA
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from corner of mouth to angle of mandible
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Measuring NPA
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Tip of nose to tragus of ear
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Apply ECG correctly:
White lead to: |
white lead to right shoulder
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red lead
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red lead to left ribs
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Black, green or brown lead to
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left shoulder
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energy from pads (AED)
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0,5 - 1 J/kg
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Site for IO insertion
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anterior tibia
distal femor medial malleolus anterior superior iliac spine |
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Contraindications for IO insertion
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fracture in extremity
previous attempt in extremity that entered marrow space infection overlying bone |
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PAT
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pediatric assessment triangle
appearance, work of breathing, circulation |
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primary assessment
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ABCDE ASSESSMENT
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how to assess breathing
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RR; Resp effort; tidal volume; airway and lung sounds; pulse ox
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how to assess circulation
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skin color and temp
HR and rhythm pulses capillary refill time BP |
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how to assess disability
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AVPU ped response scale
glascow coma scale (GSA) pupolliary responses |
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how to assess exposure
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remove clothing;
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secondary assessments
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SAMPLE
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ACDA
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Assess
Catagorize Decide Act |
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Pediatric Flowchart
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General Assessment
Primary Assessment Secondary Assessment Tertiary Assessment |
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General Assessment
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Appearnce
Work of Breathing Circulation |
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Primary Assessment
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ABCDE
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Secondary Assessment
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SAMPLE history, PE, bedside glucose
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Catagorize illness by type and severity
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Respiratory and Circulatory
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Respiratory
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Respiratory distress or failure
upper airway obst lower airway obst lung tissue disease disordered control of breathing |
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Circulatory
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compensated shock or hypotensive shock
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If life threatening condition began life saving interventions such as;
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Support ABC's
provide 100% O2 bag mask ; ET intubation |
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Clinical signs of cardiac arrest:
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apnea or agonal gasps
no palpable pulses unresponisiveness |
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Rhythms associated with pulseness arrest are:
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pulseless ventricular tachycardia (VT)
ventricular fibrillation (VF) asystole |
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If the arrest is unwittnessed then:( assumed to be asphyxial in origin) and out of hospital then:
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Start CPR immediately
Perform cycles of chest comp. and ventilations for about 2 minutes Apply AED and follow |
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If arrest is witnessed (sudden collapse more likely to be cardiac) and in hospital arrest then:
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Send someone to activate ERS and get AED while beginning CPR.
If alone activate ERS and then begin CPR Apply AED |
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Drugs used for cardiac arrest
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Epi
Amiodarone HCl Lido Magnesium sulfate calcium chloride atropine sulfate sodium bicarbonate |
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Antiarrhythmic meds
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amiodarone
or lidocaine |
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HR - Newborn
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Mean - 140
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HR - 3 months - 2 years
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Mean - 130
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HR - 2 - 10 years
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Mean - 80
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HR more than 10 years
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Mean - 75
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Signs of bradyarrhythmias
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shock with hypotension
poor end organ perfusion altered level of consciousness sudden collapse |
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Drugs used to treat bradyarrhythmias
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atopine
epinephrine |
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Drugs used to treat tachyarrhythmias are
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adenosine
amiodarone lidocaine procainamide sodium bicarbonate |
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Tachycardia is an important early sign of
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Shock
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Following drugs are used in cardiac arrest
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Epi
Amiodarone HCl lido magnesium sulfate calcium chloride atropine sulfate sodium bicarb |
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Signs of bradyarrhythmias
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shock with hypotension
poor end-organ perfusion altered level of cons sudden collapse |
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Signs of tachyarrhythmias
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resp distress
shock with hypotension poor-end organ perfusion altered level of cons sudden collapse |
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Classification of tachyarrhythmias
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NARROW COMPLEX-
sinus tachy atrial flutter supravent. tachy ( SVT) WIDE COMPLEX supravent tachy ventricular tachycardia |
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Upper airway obstruction
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stridor ( inspiratory)
seal like cough hoarseneess |
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lower airway obstruction
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wheezing (expiratory)
prolonged expiratory phase |
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lung tissue disease
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grunting
crackles decreased breath sounds |
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Following drugs can be used for respiratory emergencies
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albuterol
corticosteroids (dexamethasone) diphenhydramine epi furosemide ipratropium bromide magnesium sulfate oxygen terbutaline |
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hypoglycemia
term neonates |
less than 45 mg/dL
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hypoglycemia
infants children adolescents |
less than 60 mg/dL
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adenosine
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SVT
0.1 mg/kg rapid push (max 6mg) then 0.2 mg/kg rapid push (max 12mg) |
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albuterol
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asthma
anaphylaxis (bronchospasom) hyperkalemia |
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atropine sulfate
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bradycardia (symptomatic)
Toxins Overdose |
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Calcium chloride 10%
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hypocalcemia
hyperkalemia hypermagnesemia calcium channel blocker overdose |
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dexamethasone
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Croup
0.6 mg/kg (max 16mg) |
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dextrose
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hypoglycemia
0.5 to 1 g/kg |
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diphenhydramine
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anaphylactic shock
1 to 2 mg/kg q 4-6 hrs (max 50mg) |
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dopamine
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cardiogenic shock; distributive shock
2 - 20 microg/kg per minute |
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epi
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pulse less arrest, bradycardia
hypotensive shock anaphylaxis asthma croup; toxins/overdose |
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hydrocortisone
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adrenal insufficiency
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lidocaine
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VF/ Pulseless Vt- wide complex tachycardia (with pulses)
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Amiodarone 5mg/kg IO
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treatment of life threatening ventricular arrhythmias in children. Used in txt of shock-refractory or recurrent VT
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Estimate lower limit of systolic BP in children
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70 mm + (2 X age)
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Formula to estimate size of uncuffed endotracheal tube for children age 1 - 10 years
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(Age in years + 16)/ 4
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ABCDE
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A - Airway
B - Breathing C - Circulation D - Disability E - Exposure |
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Normal urine output infants and young children
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1.5 - 2 mL/kg per hour
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Normal urine output for older children and adolescents
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1mL/kg per hour
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Checking Disability
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evaluation of 2 components of CNS
the cerebral cortex the brainstem |
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Alert
Voice Painful Unresponsive |
Checking disability
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PERRL
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Pupils Equal Round Reactive to Light
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survival rates from ped cardiac arrest vary according to
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location of arrest
the presenting of rhythm |
