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PALS > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

what is symptomatic bradycardia

A

HR slower than normal for child’s age (usually

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2
Q

what is symptomatic bradycardia

A

HR slower than normal for child’s age (usually

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3
Q

leading cause of symptomatic bradycardia in children

A

tissue hypoxia

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4
Q

bradycardia due to congential or acquired heart conditions

A

primary bradycarida

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5
Q

Causes of secondary bradycardia

A

hypoxia, acidosis, HYPOTN, hypothermia, drug effects

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6
Q

2 common types of bradyarrythmias in children

A

sinus bradycardia and AV block

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7
Q

normal heart rate for newborn to 3 months

A

85-205

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8
Q

normal heart rate for 3 months to 2 years

A

100-190

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9
Q

normal haert rate for 2-10 yaers

A

60-140

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10
Q

normal heart rate for >10

A

60-100

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11
Q

epi IV/IO drug dosage

A

0.01 mg/kg (0.1 mL/kg) of 1:10,000 concentration

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12
Q

epi ET drug dosage

A

0.1 mg/kg (0.1mL/kg of 1:1000)

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13
Q

atropine IO/IV dose

A

0.02 mg/kg (can repeat once)

min- 0.1 mg max- 0.5 mg

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14
Q

how often can epi be repeated

A

every 3-5 minutes

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15
Q

for persistent bradycardia what should be considered

A

continuous infusion of epinephrine (0.1 to 0.3 mcg/kg per minute)

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16
Q

ET dosage for atropine

A

0.04 to 0.06 mg/kg

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17
Q

fast heart rate from a normal response to stress or fever

A

sinus tachycardia

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18
Q

fast abnormal rhythms originating either in the atria or the ventricles of the heart. can cause hemodynamic compromise (shock or deterioration)

A

tachycarrhythmias

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19
Q

when does coronary perfusion occur

A

diastole

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20
Q

narrow complex (

A

sinus tachycardia, SVT, atrial flutter

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21
Q

wide complex (>0.09) tachycarrhythmias

A

ventricular tachycardia, SVT w/ aberrant intraventricular conduction

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22
Q

sinus tachycardia is usually

A

220

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23
Q

sinus tachycardia is usually

A
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24
Q

what is the most common tachyarrhythmias that causes CV compromise during infancy

A

SVT

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25
Q

ways to identify SVT

A

absent or abnormal P waves, narrow QRS, HR >220 in infants, HR >180 in children

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26
Q

ways to identify SVT

A

absent or abnormal P waves, narrow QRS, HR >220 in infants, HR >180 in children

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27
Q

leading cause of symptomatic bradycardia in children

A

tissue hypoxia

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28
Q

conditions that can lead to torsades

A

long QT, hypomagnesemia, hypokalemia, antiarrhythmic drug toxicity or other drug toxicitites (TCAs, CCBs, phenothiazines)

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29
Q

Causes of secondary bradycardia

A

hypoxia, acidosis, HYPOTN, hypothermia, drug effects

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30
Q

2 common types of bradyarrythmias in children

A

sinus bradycardia and AV block

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31
Q

normal heart rate for newborn to 3 months

A

85-205

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32
Q

normal heart rate for 3 months to 2 years

A

100-190

33
Q

normal haert rate for 2-10 yaers

A

60-140

34
Q

normal heart rate for >10

A

60-100

35
Q

epi IV/IO drug dosage

A

0.01 mg/kg (0.1 mL/kg) of 1:10,000 concentration

36
Q

epi ET drug dosage

A

0.1 mg/kg (0.1mL/kg of 1:1000)

37
Q

atropine IO/IV dose

A

0.02 mg/kg (can repeat once)

min- 0.1 mg max- 0.5 mg

38
Q

how often can epi be repeated

A

every 3-5 minutes

39
Q

for persistent bradycardia what should be considered

A

continuous infusion of epinephrine (0.1 to 0.3 mcg/kg per minute)

40
Q

ET dosage for atropine

A

0.04 to 0.06 mg/kg

41
Q

fast heart rate from a normal response to stress or fever

A

sinus tachycardia

42
Q

fast abnormal rhythms originating either in the atria or the ventricles of the heart. can cause hemodynamic compromise (shock or deterioration)

A

tachycarrhythmias

43
Q

when does coronary perfusion occur

A

diastole

44
Q

narrow complex (

A

sinus tachycardia, SVT, atrial flutter

45
Q

wide complex (>0.09) tachycarrhythmias

A

ventricular tachycardia, SVT w/ aberrant intraventricular conduction

46
Q

sinus tachycardia is usually

A

220

47
Q

sinus tachycardia is usually

A
48
Q

what is the most common tachyarrhythmias that causes CV compromise during infancy

A

SVT

49
Q

common signs of SVT in infants

A

irritability, poor feeding, rapid breathing, unusual sleepiness, vomiting, pale, mottled, gray or cyanotic skin

50
Q

ways to identify SVT

A

absent or abnormal P waves, narrow QRS, HR >220 in infants, HR >180 in children

51
Q

what leas will P waves be absent/abnormal/inverted in SVT

A

inferior (II/III/aVF)

52
Q

signs of CHF can be present with what

A

SVT

53
Q

conditions that can lead to torsades

A

long QT, hypomagnesemia, hypokalemia, antiarrhythmic drug toxicity or other drug toxicitites (TCAs, CCBs, phenothiazines)

54
Q

vagal maneuver for infants/ children of all ages

A

ice to the face

55
Q

other vagal maneuvers for children

A

blow through a narrow straw, carotid massage

56
Q

when are synchronized shocks used

A

cardioversion from SVT and VT with a pulse

57
Q

when should a synchronized shock occur in the cardiac cycle

A

coincide with teh R wave of the patient’s QRS (prevent VF that coud occur during the T wave period

58
Q

what is the initial dose for a synchronized shock

A

0.5-1 J/kg

59
Q

what is the subsequent doses for synchronized cardioversion

A

2 J/ kg

60
Q

if VF develops after synchronized cardioversion what should be done?

A

immediately begin CPR and prepare to deliver an unsynchronized shock

61
Q

indications for synchronized cardioversion

A

hemodynamically unstable patients (poor perfusion, HPOTN, heart failure), with tachycarrhythmias (SVT, atrial flutter, VT) but with palpable pulses

62
Q

half life of adenosine

A
63
Q

can adenosine be given via the IO route

A

yes

64
Q

adenosine dosing

A

0.1 mg/kg (max 6 mg) rapid IV bolus

2nd dose 0.2 mg/kg (max 12 kg)

65
Q

when can amiodarone be considered fur use with tachyarrhythmias

A

hemodynamically stable SVT refractory to vagal manuevers and adenosine

66
Q

how does amiodarone work

A

inhibits alpha nad beta adreenergic receptors leading to vasodilation and AV nodal suppression, prolongs QT interval, slows conduction by inhibiting sodium channels and prolonging QRS duration

67
Q

dosage of amiodarone for SVT/ ventricular arrhythmias w/ poor perfusion

A

loading dose of 5 mg/kg infused over 20-60 minutes

max of 15 mg/kg per day as needed (should not exceed 2.2 g over 24 hours)

68
Q

why does amiodarone increase the risk for polymoprhic VT

A

prolongs teh QT interval

69
Q

dosage of procainamide

A

loading dose of 15 mg/kg over 30-60 minutes w/ continuously monitoring EKG and BP

70
Q

MOA of procainamide

A

blocks sodium channels to prolong the effective refractory period of both atria and ventricles.

71
Q

what is an alternative agent for stable VT, not effective for suprventricular arrhythmias

A

lidocaine

72
Q

MOA of lidocaine

A

Na channel blocker, decreases automaticity and suppresses wide complex ventricular arrhythmias

73
Q

dosage of lidocaine

A

loading IV dose of 1 mg/kg, consider infusion fo 20-50 mcg/kg/minute

74
Q

mag sulfate dose

A

25-50 mg/kg IV/IO (max 2 g) given over 10-20 minutes (faster if torsades w/ cardiac arrest)

75
Q

why should verapamil NOT be used on infants in SVT

A

can lead to refractory HYPOTN and cardiac arrest

76
Q

dosage of verpamail

A

0.1 mg/kg (up to 5 mg) over at least 2 minutes

77
Q

what is the treatment for sinus tach

A

directed at teh cause. don’t use drugs to try to decrease teh HR. try to search for and treat the cause

78
Q

1st line tx for SVT

A

vagal manuevers (bag of ice, blow through straw, carotid massage)

79
Q

if SVT doesn’t respond to meds and the child is hemodynamically stable what should you do

A

consult a pediatric cardiologist before proceeding w/ synchronized cardioversion

PALS (4 decks)

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