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Mastering EKG Interpretation: Pediatric Rhythm Analysis and Management Strategies

This comprehensive guide by Dr. T. Petrillo-Albarano delves into the critical aspects of EKG interpretation in pediatric patients. Learn to identify the components of an EKG, including P waves, QRS complexes, and T waves, alongside normal heart rate ranges for different age groups. The guide emphasizes the recognition of bradycardia, tachycardia, and emergency rhythms like pulseless arrest. With algorithms for managing bradycardia and tachyarrhythmias, this resource is essential for healthcare professionals aiming to enhance their skills in pediatric critical care.

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Mastering EKG Interpretation: Pediatric Rhythm Analysis and Management Strategies

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  1. Reading and Interpreting EKG T Petrillo-Albarano, MD Division of Pediatric Critical Care Children’s Healthcare of Atlanta

  2. The EKG • P wave • Depolarization atria • QRS • Depolarization ventricle • T wave • Repolarization Ventricle

  3. EKG (pic of QRS)

  4. Normal Rates • O-3 months 85-205 (140) • 3m-2years 100-190 (130) • 2-10years 60-140 (80) • > 10years 60-100 (75)

  5. Determining Rates (counting boxes)

  6. Identifying Rhythm • Too Slow • bradycardia • Too Fast • tachycardia • Absent • Pulseless arrest

  7. Bradycardia (strip)

  8. 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

  9. Bradycardia Algorithm

  10. 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

  11. Sinus Tachycardia • Causes? • Hypovolemia • Fever • Anxiety • Pain • Metabolic stressors • drugs

  12. 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

  13. Sinus Tachycardia (strip)

  14. 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

  15. SVT • Assess Perfusion • Good perfusion: • Call cardiology • Vagal maneuvers • Adenosine • Poor perfusion • Cardioversion • Adenosine • Beta blockers

  16. SVT (strip)

  17. 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

  18. V Tach

  19. Tachycardia Algorithm

  20. Pulseless Rhythms • VT • V-fib • PEA • Asystole

  21. V Fib

  22. V Tach

  23. PEA

  24. Asystole

  25. Pulseless Algorithm

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