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Any change in the normal sequence of the electrical impulses from the sinus node ... Reanimation child < 8 years old. Arrhyhtmia-CPR. Reanimation pediatrics ...

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Recognizing heartrhythm disturbances in psg l.jpg

Recognizing heartrhythm disturbances in PSG

Ann Ryckx


Arrhythmias l.jpg

Arrhythmias

Any change in the normal sequence of the electrical impulses from the sinus node (SA) to the ventricles can cause arrhythmia


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  • P-wave: contraction of the atria

  • QRS-complex: contraction of the ventricles

  • T-wave: recovery of the ventricles


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ECG in PSG

  • Mostly only 1 channel

  • Recognition of heartrhythm disturbances

  • Not a diagnostic tool for other heartpathologies s.a. signs of ischaemia


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Tachy-arrhythmia (too fast: > 100 bpm)Brady-arrhyhthmia(too slow: < 60 bpm)


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Atrial arrhythmia

An atrial arrhythmia is an arrhythmia caused by

  • a dysfunction of the sinus node or

  • the development of another atrial pacemaker within the heart tissue that takes over the rhythm of the sinus node


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Sinus Tachykardia

A condition in which the heart rate is faster than 100 beats per minute because the sinus node is sending out electrical impulses at a rate faster than usual


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Supraventricular tachycardia = paroxysmal atrial tachycardia


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AF: Atrial fibrillation


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Atrial flutter

The electrical signals come from the atria at a fast but even rate.

When the signals from the atria are coming at a faster rate than the ventricles can respond to, the ECG pattern develops a "sawtooth" pattern, showing two or more flutter waves between each QRS complex.


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Atrial extra systoly = premature beat


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Ventricular arrhythmia

A ventricular arrhythmia is an arrhythmia caused by

  • a dysfunction of the sinus node

  • an interruption in the conduction pathways

  • the development of another pacemaker


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Atrial ventricular BlockAV Block


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Prolonged pr-interval

(>200 msec)

Atrial ventricular AV Block 1st degree


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Atrial ventricular AV Block2nd degree

  • Wenckebach. Progressive prolongation PR interval until a p-wave is blocked

  • Mobitz Type II: pr-interval constant, evt. shorter after a p-wave block


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Atrial ventricular AV Block3d degree

  • No atrial impulses reach the ventricles

  • Possibly lifethreatening if the subsidiary pacing in the ventricles is not sufficiant


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Ventricular tachycardia

!! Life threatening !!


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PVC:Premature ventricular complexe


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Bigeminy


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Trigeminy


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Multifocal PVC


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Ventricular tachycardia


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Ventricular flutter

!! Emergency !!


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Ventricular fibrillation

!! Emergency !!


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Asystoly

!! Emergency !!


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CPR Cardio Pulmonary Resuscitation

Newest guidelines


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Step 1: check consciousness


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Step 2: call for help


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ABCD of basic life support


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Check and free the upper airway


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Hyperextension, lift the chin


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Close the nose, hyperextension


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2 breaths, deep and slow


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Check the circulation: carotis


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Automatic External Defibrillation (AED)


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No circulation:No AED available

Basic Life Support

  • 15 compressions on the chest

  • 2 breaths

  • Same rhythm, even if 2 reanimators


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Check for the lower ribs


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Lower third of the sternum


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Arms stretched, 4-5 cm impression, rhythm 100/min.


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15 compressions / 2 breaths


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No circulationAED available

  • In case of fibrillation or ventricular tachycardia connect the patient to the AED , perform analysis

  • Without pulse: defibrillation

  • Repeat ABC

  • No result: restart BLS and defibrillation after 1 minute

  • No fibrillation: BLS


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Automatic External Defibrillation (AED)


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Automatic External Defibrillation (AED)


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Safetyposition after reanimation


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THANKS !!


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