PALS - Cardiac Distr

8/8/2019 PALS - Cardiac Distr

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PEDIATRIC CARDIACRHYTHM DISTURBANCES


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Principles of Therapy Should be treated as an emergency only ifit

compromises cardiac output.

Classified according to their effect on

central pulses

- Fast pulse rate = tachyarrhythmia

- Slow pulse rate = bradyarrhythmia

- Absent pulse = pulseless arrest


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TACHYARRHYTHMIAS Sinus Tachycardia

Supraventicular Tachycardia

Ventricular Tachycardia


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G

eneralG

ui

deli

nes Evaluate 12 lead ECGifpractical

Determine the QRS duration

- Normal for age ( < 0.08 sec )

- Wide for age ( > 0.08 sec


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Si

nus Tachycardi

a A rate ofsinus discharge higher than normal

for age

Develops in response to a need for

increased cardiac output

Common causes include anxiety, fever,

pain

History is compatible for S. tach


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Si

nus Tachycardi

a ECG: rate is greater than normal for age

< 220 bpm infants

< 180 bpm in children

P waves present and normal

HR varies with activity

Variable RR with constant PRinterval


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Si

nus Tachycardi

a Therapy:

Directed at treating the underlying

cause.

Attempts at decreasing heart rate by

meds is inappropriate.


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Supraventricular Tachycardia

(SVT) Differentiate between S. tach and SVT

History is incompatible

Heart rate not variable with activity infants rate is usually > 220bpm

children rate is usually > 180 bpm

(SVT : abrupt rate change to and from normalRhythm: QRS duration usually normal for ageapprox. < 0.08 sec))


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Poor Perf

usi

on pg 90 Therapy:

- Consider vagal maneuvers (without delay)

- Synchronized cardioversion - Initial energy 0.51.0 J/kg may increase to 2 J/kg if rhythm persist.

or

- Adenosine: rapid IV /IO bolus 0.1mg/kg (max

first dose is 6 mg)repeated once at double dose (max second dose

12mg)


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Poor Perf

usi

on pg 90 Alternative Medications

Amiodarone 5mg/kg IV over 20-60 minutes

Procainimide 15mg/kg over 30-60 minutes


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Ventri

cular Tachycardi

a VT with a pulse vs VT without a pulse

VT without a pulse is treated like v. fib

ECG: QRS wide for age > 0.08 sec rate is at

least 180 bpm.


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Ventri

cular Tachycardi

a Therapy:

Immediate cardioversion 0.5-1.0J/kg

Amiodarone 5mg/kg IV over 20-60 minuteor

Procainimide 15mg/kg over 30-60 minutes

or

Lidocaine: loading dose of1 mg/kg followed byinfusing 20-50ug/kg per minute.


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Sinus Tachycardia

A rate ofsinus discharge higher than normal

for age

Develops in response to a need for

increased cardiac output

Common causes include anxiety, fever,

pain

History is compatible for S. tach


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Sinus Tachycardia

ECG: rate is greater than normal for age

< 220 bpm infants

< 180 bpm in children

P waves present and normal

HR varies with activity

Variable RR with constant PRinterval


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Sinus Tachycardia

Therapy:

Directed at treating the underlying

cause.

Attempts at decreasing heart rate by

meds is inappropriate.


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Adequate Perfusion pg 90Differentiate between S. tach and SVT

History is incompatible

Heart rate not variable w

ith act

ivity

infants rate is usually > 220bpm

children rate is usually > 180 bpm

(SVT : abrupt rate change to and from normalRhythm: QRS duration usually normal for ageapprox. < 0.08 sec))


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Adequate Perfusion pg 90

Therapy:

Consider Vagal Maneuvers

Adenosine: rapid IV /IO bolus 0.1mg/kg(max first dose is 6 mg)

repeated once at double dose (max second dose12mg)

Consult cardiologistAttempt cardioversion 0.5-1.0 J/kg may

increase to 2 J/kg


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Adequate Perf

usi

on VT with a pulse vs VT without a pulse

VT without a pulse is treated like v. fib

ECG: QRS wide for age > 0.08 sec rate is at

least 180 bpm.


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Adequate Perfusion

Therapy:

Amiodarone 5mg/kg IV over 20-60 minute

orProcainimide 15mg/kg over 30-60 minutes

or

Lidocaine: loading dose of1 mg/kg followed by

infusing 20-50ug/kg per minute.

Cardioversion 0.5-1.0J/kg


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Bradyarrhythmias

Cardiorespiratory compromise:

Poor perfusion

Hypotension

Respiratory difficulty

Altered consciousness


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Bradycardia

Heart rate < 60 bpm associated with poorperfusion should be treated.

Therapy:

Epinephrine 0.01 mg/kg of1:10,000

0.1mg/kg 1:1000 ET

Atropine: 0.02mg/kg ( minimum

dose 0.1 mg maybe repeated onceConsider pacing


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Pulseless Arrest

Asystole

Ventricular Fib.

PEA


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Pulseless Arrest

Asystole: CPR

IV / IO access

Epinephrine, first dose 01 mg/kg

1: 10,000. ET 0.1 mg/kg 1:1000


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Pulseless Arrest

Ventricular Fib

attempt up to 3 times; 2J/kg 2-4J/kg, 4J/kg

Epinephrine

Epinephrine, first dose 01 mg/kg 1: 10,000. ET

0.1 mg/kg 1:1000

Amiodarone 5mg/kg IV/IO


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Pulseless Arrest

Lidocaine

1mg/kg bolus

Magnesium

25-50mg/Kg IV/IO fot torsades

de pointes or hypomagnesemia


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PEA

Identify and treat underlying cause

CPR

IV/IO access

Epinephrine

PALS - Cardiac Distr

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