Paediatrics: Rhythm disturbances

Rhythm disturbances

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Bradycardia

·  Bradycardia is often the final response to hypoxia.

·  A preterminal rhythm leading to asystole.

Treatment

·  Oxygen, with attention to airway and inflation.

·  Epinephrine 10 micrograms/kg IV

·  May require atropine 20 micrograms/kg IV (minimum 100 micrograms; maximum 1mg) if triggered by vagal stimulation.

Sinus tachycardia

·  Heart rate can be as high as 220/min in an infant, but not higher.

·  Caused by fever, pain, and shock.

Treatment 

Treat the cause.

Supraventricular tachycardia

·  The most common primary arrhythmia in infancy and childhood.

·  Onset sudden. Heart rate: >220/min in infants; >180/min in children over 3yrs.

·  Rhythm is regular and P waves may not be visible.

·  Infants may present with shock, sweatiness, and poor feeding.

Ventricular tachycardia

·  Rare in children; caused by primary cardiac problem or overdose.

·  Heart rate: between 120 and 250/min.

·  Rhythm is almost regular, but QRS is wide (>2 small squares).

Treatment

·  Pulse present: amiodarone 5mg/kg; synchronized shock.

·  Pulseless: treat as for VF.

Ventricular fibrillation

·  Mainly caused by hypothermia and drug overdose.

·  Found in 27% of all paediatric in-hospital arrests.

Asystole

·  Mainly caused by hypoxia and acidosis.

·  60% of all paediatric arrests.

Pulseless electrical activity