Paediatrics: Rhythm disturbances

2021-03-10 12:00 AM

Bradycardia is often the final response to hypoxia.

Rhythm disturbances


  • Bradycardia is often the final response to hypoxia.
  • A preterminal rhythm leading to asystole.


  • 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.


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).


  • 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.


  • Mainly caused by hypoxia and acidosis.
  • 60% of all paediatric arrests.

Pulseless electrical activity