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Reading and Interpreting EKG. T Petrillo-Albarano, MD Division of Pediatric Critical Care Children’s Healthcare of Atlanta. The EKG. P wave Depolarization atria QRS Depolarization ventricle T wave Repolarization Ventricle. EKG (pic of QRS). Normal Rates. O-3 months 85-205 (140)
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Reading and Interpreting EKG T Petrillo-Albarano, MD Division of Pediatric Critical Care Children’s Healthcare of Atlanta
The EKG • P wave • Depolarization atria • QRS • Depolarization ventricle • T wave • Repolarization Ventricle
Normal Rates • O-3 months 85-205 (140) • 3m-2years 100-190 (130) • 2-10years 60-140 (80) • > 10years 60-100 (75)
Identifying Rhythm • Too Slow • bradycardia • Too Fast • tachycardia • Absent • Pulseless arrest
Bradycardia • HR less than 60 • Associated with poor perfusion • Can be caused by many factors • Hypotension, hypoxemia, acidosis, ingestion • In children Hypoxemia is often culprit • Support the airway
Tachy-arrhythmias • ABC • Adequate airway • Respiratory effort • Does the child have a pulse? • No Pulse: CPR; define rhythm • Positive pulse.. Define rhythm • Assess QRS duration
Sinus Tachycardia • Causes? • Hypovolemia • Fever • Anxiety • Pain • Metabolic stressors • drugs
Sinus Tachycardia • P waves present and normal • Variability to rate • Constant PR interval • Infants usually less than 220; children usually less than 180 • Treat the cause
Supra-ventricular Tachycardia • Usual sudden onset • No history to support ST • P waves are often absent ( but can be present) • Abrupt changes • Usually greater than 220 or 180
SVT • Assess Perfusion • Good perfusion: • Call cardiology • Vagal maneuvers • Adenosine • Poor perfusion • Cardioversion • Adenosine • Beta blockers
V Tach with pulse • Most will have underlying congenital heart disease or myocarditis/ cardiomyopathy • Can be related to electrolyte imbalance, toxin, drugs • Cardioversion • Consider Amiodirone
Pulseless Rhythms • VT • V-fib • PEA • Asystole