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Archived - Pediatric Advanced Life Support (PALS) 2020 > 1 - Arrhythmias > Flashcards

1 - Arrhythmias Flashcards

1
Q

Bradycardia

A

<60 HR

w/ Cardiopulmonary Compromise

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2
Q

What is Cardiac Compromise

A

Cardiopulmonary Compromise = hypotension, AMS, DLOC, Shock

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3
Q

Primary Bradycardia

A

Result of congenital heart condition

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4
Q

Primary Bradycardia examples

A

Myocarditis
Cardiomyopathy
Surgical injury to the pacemaker
Congenital abnormality

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5
Q

Secondary Bradycardia

A

Result of noncardiac conditions

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6
Q

Secondary Bradycardia examples

A 
Hypoxia
Acidosis
Hypotension
Hypothermia
Drug Effects
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7
Q

STUDY AV BLOCKS

A

STUDY AV BLOCKS

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8
Q

Narrow QRS

A

<0.09 seconds

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9
Q

Wide QRS

A

> 0.09 seconds

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10
Q

Narrow Complex Tachycardia

A

Sinus taachy
Supraventricular tachy
Atrial flutter

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11
Q

Wide Complex Tachycardia

A

Ventricular tachycardia

SVT

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12
Q

Etopic atrial focus

A

abnormal pacemaker sites within the heart
normally suppressed by SA node
occur in atria or ventricles

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13
Q

HR in ST

A

Infants <220 min

Chldren <180 min

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14
Q

ST Hx

A

Gradual Onset

Fever, pain, dehydration, hemorrhage

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15
Q

ST PE

A

Crackles, fever, hypovolmeia, anemia

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16
Q

HR in SVT

A

Infants >220

Children >180

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17
Q

SVT Hx

A

Abrupt onset

Infant: CHF
Child: Palpitations

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18
Q

SVT PE

A

CHF

Rales, hepatomegaly, edema

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19
Q

Ventricular Tachycardia

A

Wide QRS complex

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20
Q

2 Forms of VT

A 
Monomorphic
Polymorphic (Torsades de pointes)
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21
Q

Atropine dosage

A

0.02 mg/kg - May repeat dose ONCE
Minimum dose 0.1 mg
Max single dose 0.5 mg

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22
Q

<60 HR w/ cardiopulmonary compromise?

A

CPR

23
Q

<60 Hr w/ cardiopulmonary compromise persisting with CPR…

A

Epi
Atropine
Transthoracic/Transvenous Pacing

24
Q

What is increased vagal tone

A

Vagal Nerve
Activates parasympathetic nervous tone
Your body relaxes faster after stress

25
Q

What is atropine used for

A

increased vagal tone
AV block
Cholinergic drug toxicity
(epi can cause ventricular arrhythmias during these circumstances)

26
Q

Epi has both

A

alpha and beta adrenergic activity

27
Q

What does Beta adrenergic do

A

Increases HR & cardiac contractility

28
Q

What does Alpha adrenergic do

A

Causes vasoconstriction

29
Q

The effects of epi and other catecholamines can be reduced by

A

acidosis and hypoxia

30
Q

What is a parasympatholytic

A

Reduces the activity of the parasympathetic nervous system

31
Q

Atropine what type of drug

A

parasmypatholytic (anticholinergic)

32
Q

How does atropine work on the body

A

It accelerates sinus or atrial pacemakers and enhances AV conduction

33
Q

What does cholinergic do?

A

Mimics acetylcholine

34
Q

What is acetylcholine

A

Primary transmitter of nerve impulses in the parasympathetic nervous system

35
Q

What can be used for tx of Mobitz I & II, and third-degree AV block?

A

Atropine

36
Q

Atropine dose in ET

A

0.04 to 0.06 mg/kg

37
Q

What do cholinesterase inhibitors do

A

Prevent the breakdown of acetylcholine or butyrylcholine

38
Q

Vagal maneuvers to terminate SVT

A

Ice on the face for 15 to 20 seconds
Blow through a straw
Carotid sinus massage in older children
Do not apply ocular pressure - retinal injury

39
Q

When are unsynchronized shocks used

A

For defibrillation because the cardiac arrest rhythms have no QRS

40
Q

synchronized shocks are used

A

from SVT and VT

41
Q

When does the synchronized shock hit

A

R wave

42
Q

What happens if you don’t hit the synchronized shock

A

it could lead to VF because you could hit the vulnerable period of the T wave

43
Q

Cardioversion dosage

A

Start w/ 0.5 to 1 J/Kg
inc 2 J/kg

0.5 - 1 - 2

44
Q

Drug choice for tx f SVT

A

Adenosine

45
Q

What is Adenosine dosage

A

RAPID IV BOLUS

  1. 1 mg/kg (max first 6mg)
  2. 2 mg/kg (max second 12mg)
46
Q

Decrease the dose of Adenosine for those w/

A

transplanted hearts

47
Q

Adenosine MOA

A

Blocks conduction through the AV node temporarily

48
Q

Atrioventricular node reentry

A

Causes the heart to beat prematurely

49
Q

Amiodarone Dosage

A

5 mg/kg loading dose over 20 - 60 minutes
Max single dose 300mg
Max 15 mg/kg a day
(Not exceed adult dose of 2.2g over 24 hours)

50
Q

Why is a slower rate of Amio advised?

A

Because it can cause hypotension and decreased cardiac contractility

51
Q

Drug that can terminate SVT that is resistant to other drugs

A

Procainamide

52
Q

How does procainamide work?

A

Blocks the sodium channel

Prolongs the effective refractory period of the atria and ventricles

53
Q

Procainamide dose

A

Infuse a loading dose of 15mg/kg over 30 - 60 mins

54
Q

What drug should you not use in infants for SVT

A

Verapmil - CCB

Has caused refractory hypotension and cardiac arrest

Archived - Pediatric Advanced Life Support (PALS) 2020 (23 decks)

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