2013 pediatric subspecialty boot camp_dysrhythmias

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

xxx00.#####.ppt 07/05/13 09:17 PMPediatrics

ObjectivesObjectives

• Approach to critical dysrhythmias

• Review normal conduction system

• Review common pediatric dysrhythmias

• Management of critical dysrhythmias


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


But… what if you see this on the But… what if you see this on the monitor??monitor??


Approach to dysrhythmiasApproach to dysrhythmias

• Pulse? conscious?

• Narrow or wide?

• P wave?

• Regular or Irregular?

• Slow or fast?


Normal conduction systemNormal conduction system


Mechanism of dysrhythmiasMechanism of dysrhythmias

• Reentry

• Automaticity

• Triggered activity

• Delay and blocks

Tachycardia

Bradycardia


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


Atrial dysrhythmiasAtrial dysrhythmiasA Flutter A Fib

PAC AET


Junctional dysrhythmias Junctional dysrhythmias

SVT

JET


Ventricular dysrhythmias Ventricular dysrhythmias

PVCs

V Tach

V Fib


BradycardiasBradycardias

1st degree block

2nd degree block

3rd degree block

Mobitz 1

Mobitz 2


ManagementManagement

• CAB

• PALS

• After stabilization Investigate cause


PALS pulseless arrestPALS pulseless arrest


PALS tachycardia with pulsePALS tachycardia with pulse


PALS Bradycardia with pulsePALS Bradycardia with pulse


QuestionsQuestions

?

2013 pediatric subspecialty boot camp_dysrhythmias

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