Paediatrics: Rhythm disturbances

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