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46 Cards in this Set
- Front
- Back
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0-3 month
Heart rate |
Mean 140
Awake 85-205 Sleep 80-160 |
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3 mon-2 years
Heart rate |
Mean 130
Awake 100-190 Sleep 75-160 |
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2-10 years
Heart rate |
Mean 80
Awake 60-140 Sleep 60-90 |
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> 10 years
Heart rate |
Mean 75
Awake 60-100 Sleep 50-90 |
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Tachyarrhythmias
Nonspecific signs |
Heart palpitations
Light-headedness syncope |
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Congestive heart failure signs
in an infant |
Poor feeding
irritability rapid breathing hepatomegaly edema crackles lungs |
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Tachyarrhythmias
Hemodynamically unstable |
respiratory distres/failure
signs of shock with or without hypotension Altered mental status Sudden collapse with rapid, weak pulse |
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Narrow Complex Tach
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Sinus tach (ST)
Supraventricular tach (SVT) Atrial flutter |
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Wide Complex Tach
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Ventricular tach (VT)
Supraventricular tach (SVT) with aberrant intraventricular conduction |
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Sinus Tach
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Varies with;
respirations positional changes relaxation fluid administration |
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Sinus Tach
Causes |
exercise
pain anxiety tissue hypoxia hypovolemic shock fever metabolic stress injury toxins/poisons/drugs anemia |
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Sinus Tach
Less common causes |
cardiac tamponade
tension pneumothorax thromboembolism |
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Sinus Tach
EKG Characteristics |
Infants- Usually <220
Children- Usually <180 Variable with activity and stress P waves present/normal PR constant/normal R-R Variable QRS narrow |
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Signs of SVT
Infants |
irritability
poor feeding rapid breathing unusual sleepiness vomiting pale, mottled, gray or cyanotic skin |
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Signs of SVT
Children |
Palpitations
shortness of breath chest pain or discomfort dizziness light-headedness fainting |
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AIRWAY
SVT effects |
Usually patent unless LOC is significantly impaired
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BREATHING
SVT effects |
Tachypnea
Increased work of breathing Crackles (or wheezing in infants) if CHF develops Grunting if CHF develops |
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CIRCULATION
SVT effects |
Tachycardia beyond ST range. fixed rate/ abrupt onset
Delayed cap refill Weak peripheral pulses Cool extremities Diaphoretic, pale, mottled, gray, cyanotic skin Hypotension Jugular venous distention if CHF develops (diff. to see in young children) |
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DISABILITY
SVT effects |
Altered mental status (LOC)
Sleepiness or lethargy Irritability |
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EXPOSURE
SVT effects |
Defer eval of temp until ABC's supported
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SVT
EKG Characteristics |
Usually >220 infants
Usually >180 Children No beat to beat variability P; absent/ or abnormal PR; undeterminable R-R; Constant QRS; Narrow/ wide uncommon |
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Atrial Flutter
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Clasically a "sawtooth" pattern on EKG
can be >300 More common newborn infants with normal hearts Kids with congenital heart disease, especially following heart surg |
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V. Tach
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Uncommon among children; Electrolyte disturbances
Drug toxicity (tricyclic antidepressants, cocaine, methamphet) underlying heart disease long QT syndrome myocarditis/cardiomyopathy |
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V. Tach
EKG Characteristics |
>120/regular
QRS; wide P; usually not identifiable |
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Torsades de pointes
Wide polymorphic v.tach |
Hypomagnesemia
hypokalemia Drug toxicity (quinidine, procainamide, diisopyramide, encainide, flecainide, sotalol, amiodarone |
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Torsades de Pointes
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Can quickly deteriorate to V. fib
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CIRCULATION
Questions |
PULSES + OR -
No- Cardiac arrest algorithm Yes- Tachycardia algorithms |
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PERFUSION
Questions |
Poor or Adequate
Poor- Tachycardia with pulse/ poor perfusion algorithms Adequate- Tachycardia with pulse/ poor perfusion algorithms (Consider cardiology consult) |
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RHYTHM
Questions |
Narrow or Wide
Narrow- Differential of ST vrs SVT Wide- Differential of SVT vrs VT, treat as presumed VT unless known aberrant history |
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Atrial Flutter
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Clasically a "sawtooth" pattern on EKG
can be >300 More common newborn infants with normal hearts Kids with congenital heart disease, especially following heart surg |
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V. tach
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Uncommon in children
Wide complex >200 |
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V. Tach in children
Causes |
Electrolyte disturbances (hyperkalemia, hypocalcemia, hypomagnesemia)
Drug Toxicity (Tricyclic antidepressants, cocaine, methamphetamines) Heart disease long QT syndrome |
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V. tach
EKG characteristics |
>120
QRS; Wide P; Often not identifieable |
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V. Tach
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Assume wide complex rhythm is VT unless known aberrant conduction
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Torsades de pointes
causes |
Long QT syndrome
Hypomagnesemia Hypokalemia Antiarrhythmic Drug toxicity (quinidine, procainamide, sotalol, amiodarone) Other drug toxicity (tricyclic antidepressants, calcium channel blockers, phenothiazines) |
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Circulation
Questions |
pulse + or -
Absent- cardiac arrest algorithm Present- Tachycardia algorithm |
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Perfusion
Questions |
Poor- Tachycardia with a pulse/ poor perfusion algorithm
Adequate- Tachycardia with a pulse/ poor perfusion algorithm (consider cardiac consult) |
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Rhythm
Questions |
Narrow- Differentiate ST vrs SVT
Wide- Differentiate ST vrs VT |
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Tachycardia Management
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ABC's and O2
Monitor/ defibrillator and pulse ox IV 12 lead EKG Labs (Potassium, glucose, ionized calcium, magnesium, blood gas ph) LOC Anticipate meds identify and treat reversible causes |
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Vagal maneuvers
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Infant- ice to face 15-20 sec
child- blow through narrow straw older child- carotid sinus massage |
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Vagal maneuvers
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ABC
12 lead before and after if possible- dont delay treatment If stable- may attempt twice if first is unsuccessful If unstable- Only attempt while pharmacological and electrical conversions are being set up |
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Cardioversion
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Establish iv and sedation
If unstable, do not delay treatment for iv access |
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Potential problems with
synchronized cardioversion |
Synch button must be activated for synchronization to occur, and monitors usually return to default settings
R wave may not be identified by machine, and other lead may need to be used Staff may be unfamiliar with operation |
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Synchronized cardioversion
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Initial dose; 0.5-1 J/kg
Subsequent dose; 2 J/kg |
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When Synchronized Cardioversion is used
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Hemodynamically unstable (poor perfusion, low BP, or heart failure)
Tachyarrhythmias (SVT, atrial flutter , VT) with pulses |
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Tachycardia medications
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Adenosine
Amiodarone Procainamide Lidocaine Magnesium sulfate |
