Peds Tachycardia with a Pulse Flashcards
What things to do in the initial assessment (the very first things to do) in a Tachycardic pediatric patient?
All the logical things:
* Maintain patent airway; assist breathing as necessary
* Supp. O2
* Cardiac monitors - pulse ox, tele, BP
* IV/IO access
* ORDER 12-LEAD ECG
As always, think of 5 H’s and 5 T’s
12 Lead EKG is the initial Branching point basically (I’ll call it point 0 since hemodynamic significance is really #1 and matches with branch point #1 of adult tachycardia with a pulse). What rate/rhythm characteristics point you toward a Dx of just Sinus tachycardia?
- P waves PRESENT and NORMAL
- VARIABLE RR interval! Think of Sinus arrhythmia with breathing!
CONSTANT PR interval! - Infant rate usually < 220 bpm
- Child rate usually < 180 bpm
Treatment of Sinus Tach?
Search for and treat causes! For me, usually just TOO LIGHT!
Other than an EKG or an obvious tele reading of Sinus Tachycardia, what is the next big branching point in the peds tachycardia with a pulse PALS algorithm?
Hemodynamic Stability:
- AMS?
- Signs of Shock?
- HoTN?
Whether the child is Hemodynamically stable or not, what part of the EKG is evaluated as the last main branching points for both hemodynamically STABLE and hemodynamically UNstable Tachycardia?
QRS Duration! It’s either WIDE or NARROW
What is the exact duration of a WIDE vs NARROW Peds QRS complex?
Narrow QRS is ≤ 0.09 sec
Wide QRS is > 0.09 sec
What meds are distinctly MISSING from PEDS Tachycardia with a pulse that are a big part of ADULT with a pulse? and WHY?
RATE CONTROL meds!
- BB’s - Esmolol, Metoprolol
- CCB’s - Diltiazem
Don’t rate control in kids because their NON-compliant hearts are so reliant on HEART RATE for adequate Cardiac Output! Won’t be able to adapt by increasing SV like an adult would!
If a rhythm is [0] NOT sinus tach as shown by 12 lead EKG or obviously by tele, is [1] hemodynamically UNstable, the [2] QRS duration is ≤ 0.09 sec, what is the rhythm likely to be?
Probable SVT (Supraventricular Tachycardia)
If a rhythm is [0] NOT sinus tach as shown by 12 lead EKG or obviously by tele, is [1] hemodynamically STABLE, the [2] QRS duration is ≤ 0.09 sec, what is the rhythm likely to be?
Probable SVT (Supraventricular Tachycardia)
What are the EKG characteristics of probably SVT?
- P waves absent/abnormal
- RR interval NOT variable - big distinguishing point from Sinus tach!
- Infant rate usually HIGHER than sinus tach (≥220/min)
- Child rate usually GREATER than sinus tach (≥180/min)
- ABRUPT rate change
If a rhythm is [0] NOT sinus tach as shown by 12 lead EKG or obviously by tele, is [1] hemodynamically UNstable, the [2] QRS duration is > 0.09 sec, what is the rhythm likely to be?
Probably VT (Ventricular Tachycardia)
If a rhythm is [0] NOT sinus tach as shown by 12 lead EKG or obviously by tele, is [1] hemodynamically STABLE, the [2] QRS duration is ≤ 0.09 sec, what is the rhythm likely to be?
Probably VT (Ventricular Tachycardia)
If the kid is in hemodynamically UNstable SVT, what is the treatment algorithm?
SVT would mean a regular R-R and narrow QRS (≤ 0.09 sec). If it’s UNstable, here is the treatment algorithm:
1) Adenosine if IV/IO access is present
2) Synchronized Cardioversion if adenosine not work or if IV/IO access isn’t present
This is the SAME treatment algorithm as adults. The only time you’d consider doing anything except just a synchronized cardioversion in adults with a hemodynamically UNstable tachycardia is if it’s REGULAR and NARROW, meaning it’s an SVT, and you’d give Adenosine…so the same as here!
If the kid is in hemodynamically STABLE VT, what is the treatment algorithm?
SVT would mean a regular R-R and narrow (≤ 0.09 sec) QRS. If it’s STABLE, here is the treatment algorithm:
1) Consider VAGAL maneuvers
2) Give Adenosine if IV/IO access is present
These two treatment steps are actually the SAME treatment algorithm for adults with hemodynamically STABLE Tachycardia that has a narrow QRS! Peds algorithm here is just missing treatment steps #3 and #4 from the Adult Tachycardia algorithm, which are BB’s and CCB’s!
- Peds algorithm is also just doesn’t discuss if an SVT (narrow QRS) has an irregular RR interval, which for an adult you could give Amiodarone instead of rate control. So for peds, Rhythm control is basically reserved for WIDE QRS tachycardias (so VT basically).
If the Kid is in a hemodynamically UNstable VT, what is the treatment algorithm?
VT would mean a wide QRS (> 0.09 sec), a regular or irregular R-R, and a monomorphic or polymorphic QRS. If it is UNstable, here is the treatment algorithm:
1) Synchronized Cardioversion
2) Seek expert consultation, and they might recommend Amiodarone or Procainamide
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