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Paediatrics: Rhythm disturbances
2021-03-10 12:00 AM
Bradycardia is often the final response to hypoxia.
Rhythm disturbances
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