Pediatrics Dysrhythmias Dysrhythmias Fellow Boot Camp 2013 Fellow Boot Camp 2013 Aarti Bavare, MD. MPH Aarti Bavare, MD. MPH Pediatric Critical Care Texas Children’s Hospital and Baylor College of Medicine
Pediatrics
DysrhythmiasDysrhythmiasFellow Boot Camp 2013Fellow Boot Camp 2013
Aarti Bavare, MD. MPHAarti Bavare, MD. MPHPediatric Critical Care
Texas Children’s Hospital and Baylor College of Medicine
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ObjectivesObjectives
• Approach to critical dysrhythmias
• Review normal conduction system
• Review common pediatric dysrhythmias
• Management of critical dysrhythmias
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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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But… what if you see this on the But… what if you see this on the monitor??monitor??
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Approach to dysrhythmiasApproach to dysrhythmias
• Pulse? conscious?
• Narrow or wide?
• P wave?
• Regular or Irregular?
• Slow or fast?
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Normal conduction systemNormal conduction system
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Mechanism of dysrhythmiasMechanism of dysrhythmias
• Reentry
• Automaticity
• Triggered activity
• Delay and blocks
Tachycardia
Bradycardia
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Classification
Tachycardia Bradycardia
Supraventricular Ventricular
Atrial:-Reentry: Flutter, Fib-Ectopic: PAC, AET Junctional
-Reentry: SVT-Ectopic: JET
- Reentry: V fib- Ectopic: PVC,
VT
SAN AVN
- Sinus brady- Sick sinus
- 1st degree block- 2nd degree block:Mobitz 1 or 2- 3rd degree block
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Atrial dysrhythmiasAtrial dysrhythmiasA Flutter A Fib
PAC AET
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Junctional dysrhythmias Junctional dysrhythmias
SVT
JET
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Ventricular dysrhythmias Ventricular dysrhythmias
PVCs
V Tach
V Fib
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BradycardiasBradycardias
1st degree block
2nd degree block
3rd degree block
Mobitz 1
Mobitz 2
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ManagementManagement
• CAB
• PALS
• After stabilization Investigate cause
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PALS pulseless arrestPALS pulseless arrest
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PALS tachycardia with pulsePALS tachycardia with pulse
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PALS Bradycardia with pulsePALS Bradycardia with pulse
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QuestionsQuestions
?