2013 Pediatric Subspecialty Boot Camp_Dysrhythmias
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2013 Pediatric Subspecialty Boot Camp_Dysrhythmias
- 1. Pediatrics DysrhythmiasDysrhythmias Fellow Boot Camp 2013Fellow Boot Camp 2013 Aarti Bavare, MD. MPHAarti Bavare, MD. MPH Pediatric Critical Care Texas Children’s Hospital and Baylor College of Medicine
- 2. Page 2 xxx00.#####.ppt 07/05/13 09:17 PM Pediatrics ObjectivesObjectives • Approach to critical dysrhythmias • Review normal conduction system • Review common pediatric dysrhythmias • Management of critical dysrhythmias
- 3. Page 3 xxx00.#####.ppt 07/05/13 09:17 PM Pediatrics How do you approach an EKG?How do you approach an EKG? • Rate: Atrial, ventricular • Rhythm • Axis • Waves: P wave, QRS complex, T wave • Intervals: PR, ST, QT
- 4. Page 4 xxx00.#####.ppt 07/05/13 09:17 PM Pediatrics But… what if you see this on theBut… what if you see this on the monitor??monitor??
- 5. Page 5 xxx00.#####.ppt 07/05/13 09:17 PM Pediatrics Approach to dysrhythmiasApproach to dysrhythmias • Pulse? conscious? • Narrow or wide? • P wave? • Regular or Irregular? • Slow or fast?
- 6. Page 6 xxx00.#####.ppt 07/05/13 09:17 PM Pediatrics Normal conduction systemNormal conduction system
- 7. Page 7 xxx00.#####.ppt 07/05/13 09:17 PM Pediatrics Mechanism of dysrhythmiasMechanism of dysrhythmias • Reentry • Automaticity • Triggered activity • Delay and blocks Tachycardia Bradycardia
- 8. Page 8 xxx00.#####.ppt 07/05/13 09:17 PM Pediatrics Classification Tachycardia Bradycardia Supraventricular Ventricular Atrial: -Reentry: Flutter, Fib -Ectopic: PAC, AET Junctional -Reentry: SVT -Ectopic: JET - Reentry: V fib - Ectopic: PVC, VT SAN AVN - Sinus brady - Sick sinus - 1st degree block - 2nd degree block: Mobitz 1 or 2 - 3rd degree block
- 9. Page 9 xxx00.#####.ppt 07/05/13 09:17 PM Pediatrics Atrial dysrhythmiasAtrial dysrhythmias A Flutter A Fib PAC AET
- 10. Page 10 xxx00.#####.ppt 07/05/13 09:17 PM Pediatrics Junctional dysrhythmiasJunctional dysrhythmias SVT JET
- 11. Page 11 xxx00.#####.ppt 07/05/13 09:17 PM Pediatrics Ventricular dysrhythmiasVentricular dysrhythmias PVCs V Tach V Fib
- 12. Page 12 xxx00.#####.ppt 07/05/13 09:17 PM Pediatrics BradycardiasBradycardias 1st degree block 2nd degree block 3rd degree block Mobitz 1 Mobitz 2
- 13. Page 13 xxx00.#####.ppt 07/05/13 09:17 PM Pediatrics ManagementManagement • CAB • PALS • After stabilization Investigate cause
- 14. Page 14 xxx00.#####.ppt 07/05/13 09:17 PM Pediatrics PALS pulseless arrestPALS pulseless arrest
- 15. Page 15 xxx00.#####.ppt 07/05/13 09:17 PM Pediatrics PALS tachycardia with pulsePALS tachycardia with pulse
- 16. Page 16 xxx00.#####.ppt 07/05/13 09:17 PM Pediatrics PALS Bradycardia with pulsePALS Bradycardia with pulse
- 17. Page 17 xxx00.#####.ppt 07/05/13 09:17 PM Pediatrics QuestionsQuestions ?
Notes de l'éditeur
- xxx00.#####.ppt 07/05/13 09:17 PM P. Text Text Text Text
- SA node: rhythm generator Membrane action potential has characteristic pattern: RMP -60, slow upstroke in phase 1, no plateau phase and spont depol in phase 4 Travel across the the normal system results in characteristic pattern on EKG of atrial depolarization, AV delay, ventricular depol and vent repol EKG displays positive forces when the direction of depol is directed towards the lead recording it: hence P wave upright in lead 1 and avF when rhythm generated by sinus node. xxx00.#####.ppt 07/05/13 P.
- Reentry (SVT): common, 2 conducting pathways fast and slow with long and short refractory periods, Premature complex may get blocked by the long refractory period path paroxysmal, abrupt onset, no variability, cardioversion or AV blockade (adenosine): effective Automaticity/ Ectopic focus (JET): Ability of the cell to trigger the rhythm: usually SA nodes job, but any cell in the conduction system or cardiac tissue (focus) can take over: has features like sinus tachy: slow on/off, responsive to metabolic states, variability, no response to cardioversion or AV blockade Triggered activity (digoxin toxicity, long QT): rare, has features of both above, results from after depol: abrupt change in membrane potential during action potential xxx00.#####.ppt 07/05/13 P.
- 1 st prolongation of PR Mobitz 1: wenckebach: serial prolongation of PR with successive beats lost beat Mobitz 2: blocked Ps, 2:1, 3:1 xxx00.#####.ppt 07/05/13 P.
- Because picture is worth a 1000 words PAC: may get conducted or may get blocked, aberrant conduction may cause wide QRS AET: abnormal focus, multiple foci, may or may not get conducted xxx00.#####.ppt 07/05/13 P.
- 12 lead EKG, electrolytes, blood gas (Hs/Ts) xxx00.#####.ppt 07/05/13 P.