Exam (elaborations)
PALS 2020 ARRHYTHMIAS
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PALS 2020 ARRHYTHMIAS
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PALS 2020 ARRHYTHMIAS QUESTIONSWITH COMPLETE SOLUTION
j Whenever a child has an abnormal heart rate or rhythm, you must quickly determine? - Determine if
the arrhythmia is causing hemodynamic instability or other signs of deterioration.
What are the signs of instability in a patient with arrhythmias? - Respiratory distress or failure
Shock with poor end-organ perfusion, may occur with or without hypotension
Irritability or decreased level of consciousness
Irritability or decreased level of consciousness
chest pain or vague feeling of discomfort in older children
sudden collapse
Priorities in initially managing arrhythmias are? - The same as they are for all critically ill children:
Support ABC and treat underlying cause
Bradycardia - A heart rate that is slow in comparison with a normal heart rate range for the childs age,
level of activity and clinical condition
What is the leading cause of symptomatic bradycardia in children? - Tissue hypoxia
Symptomatic Bradycardia - Heart rate below 60/min associated with cardiopulmonary compromise
Cardiopulmonary compromise - * Hypotension
* Acutely altered mental status
* Signs of shock
Bradycardia is an ominous sign of? - Sign of impending cardiac arrest in infants and children. Especially if
hypotension or poor tissue perfusion is present
Children with severe cardiovascular compromise from pulmonary embolism, what treatment should be
considered? - Fibrinolytic agents
, What is the initial treatment of pediatric bradycardia with cardiopulmonary compromise? - Bag mask
ventilation with 100% O2
Fibrinolytic agents - tissue plasminogen activator, streptokinase, reteplase tenecteplase
Primary bradycardia - A result of congenital or acquired heart conditions
Causes of primary bradycardia - Congenital abnormality of the heart pacemaker or conduction system
Surgical injury to the pacemaker or conduction system
Cardiomyopathy
Myocarditis
Secondary bradycardia - Result of noncardiac conditions that alter the normal function of the heart (Slow
sinus node pacemaker or slow conduction)
secondary bradycardia causes - Hypoxia
Acidosis
Hypotension
Hypothermia
Drug effects
ECG characteristics of Bradycardia
HR
P wave
QRS complex
Pwave and QRS complex - HR Slow compared with normal heart rate for age
P wave May or may not be visible
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