1. Reading and Interpreting EKG T Petrillo-Albarano, MD Division of Pediatric Critical Care Children’s Healthcare of Atlanta

2. The EKG • P wave • Depolarization atria • QRS • Depolarization ventricle • T wave • Repolarization Ventricle

3. EKG (pic of QRS)

4. Normal Rates • O-3 months 85-205 (140) • 3m-2years 100-190 (130) • 2-10years 60-140 (80) • > 10years 60-100 (75)

5. Determining Rates (counting boxes)

6. Identifying Rhythm • Too Slow • bradycardia • Too Fast • tachycardia • Absent • Pulseless arrest

7. Bradycardia (strip)

8. Bradycardia • HR less than 60 • Associated with poor perfusion • Can be caused by many factors • Hypotension, hypoxemia, acidosis, ingestion • In children Hypoxemia is often culprit • Support the airway

9. Bradycardia Algorithm

10. Tachy-arrhythmias • ABC • Adequate airway • Respiratory effort • Does the child have a pulse? • No Pulse: CPR; define rhythm • Positive pulse.. Define rhythm • Assess QRS duration

11. Sinus Tachycardia • Causes? • Hypovolemia • Fever • Anxiety • Pain • Metabolic stressors • drugs

12. Sinus Tachycardia • P waves present and normal • Variability to rate • Constant PR interval • Infants usually less than 220; children usually less than 180 • Treat the cause

13. Sinus Tachycardia (strip)

14. Supra-ventricular Tachycardia • Usual sudden onset • No history to support ST • P waves are often absent ( but can be present) • Abrupt changes • Usually greater than 220 or 180

15. SVT • Assess Perfusion • Good perfusion: • Call cardiology • Vagal maneuvers • Adenosine • Poor perfusion • Cardioversion • Adenosine • Beta blockers

16. SVT (strip)

17. V Tach with pulse • Most will have underlying congenital heart disease or myocarditis/ cardiomyopathy • Can be related to electrolyte imbalance, toxin, drugs • Cardioversion • Consider Amiodirone

18. V Tach

19. Tachycardia Algorithm

20. Pulseless Rhythms • VT • V-fib • PEA • Asystole

21. V Fib

22. V Tach

23. PEA

24. Asystole

25. Pulseless Algorithm