Junctional Rhythm

Nursing Priorities and Potential Treatments (Pediatrics Nurses Required); All Other RNs Informational Only Interpreting the actual ECG rhythm is only the beginning of the assessment and care for your patient. You cannot be successful in your practice if you only know how to interpret ECG. As healthcare provider, you must be able to respond with appropriate priorities and understand initial treatments. Complete comprehensive treatments for each type of ECG rhythm are beyond the scope of this review guide. Nurses must make decisions about the patient’s treatment based on information obtained from the electrocardiogram reading. They must have the ability to read the data quickly so that they can begin medical interventions. Bradycardia Symptomatic bradycardia: Heart rate slower than normal for age or <60 (normal/age on pg.) with any signs of cardiac compromise: altered LOC, hypotension, respiratory distress or failure, poor cap refill) Types of bradycardia: Sinus bradycardia or AV block Treatment of Bradycardia: CPR for HR <60 Maintain airway - Oxygen EPI 0.1ml/kg IV/IO every 3-5 minutes (first line drug for pediatric bradycardia) Atropine 0.02mg/ml IV/IO (for bradycardia caused by increased vagal tone or AV block) Consider transvenous pacing. Tachycardia Tachycardia: Heart rate faster than is normal for the child’s age. Tachycardia with hemodynamic instability signs are: altered LOC, hypotension, poor cap refill, weak pulses, respiratory failure Sinus tachycardia- fast rate depending on age & varies with activity: HR < 220 infants HR < 180 children Treatment: identify & treat possible causes (hypovolemic, shock, fever, anxiety, toxins) SVT- Does not change with activity. Common symptoms are irritability, rapid respirations, poor feeding, poor cap refill, pallor, hypotension, and diaphoresis. +5LQIDQWV +5FKLOGUHQ Treatment: Determine if child is stable vs. unstable. If stable, attempt vagal maneuver (Ice to face). If unstable do immediate synchronized cardio version. Initial synch dose: 0.5-1 joule/kg, Subsequent synch doses: 2 joules/kg Consult cardiology!! Get a 12 lead EKG but do not delay treatment to obtain EKG For SVT resistant to vagal maneuvers: Adenosine 0.1mg/kg (max 1st dose 6mg) Rapid 2 syringe technique VT with pulses-Wide QRS. Uncommon in children. HR Normal for age to >200. Treat underlying causes: possibly due to hyperkalemia, hypocalcemia, hypomagnesaemia, toxins. Treatment for stable VT w/monomorphic QRS: Adenosine 0.1mg/kg IV/IO 1st dose (6 mg max) Adenosine 0.2mg/kg IV/IO 2nd dose (12mg max) Expert consultation Amiodarone 5mg/kg over 20-60 minutes -ORProcainamide 15mg/kg over 30-60 minutes Unstable VT: Synchronized cardioversion 0.5 to 1 J/kg (may increase to 2j/kg if ineffective) For VT refer to algorithms!!! Cardiac Arrest Shockable rhythm: Pulseless VT or VF Start CPR (at least 100 compressions/min with good chest recoil, change compressors Q2 mins) Assess cardiac rhythm Shock immediately if VT or VF (2 j/kg 1st dose) (4j/kg subsequent doses repeat every 2 minutes) Epi 0.1ml/kg every 3-5 minutes Amiodarone 5mg/kg DEAD: Defib Epi Amiodarone Defib Non-shockable rhythm: Asystole/PEA (NO defib…..NO Amio for Asystole or PEA!!) Start CPR (at least 100 compressions/min with good chest recoil, change compressors Q2 mines) Assess cardiac rhythm Epi 0.1ml every 3-5 minutes Identify & treat reversible causes: H’s Hypovolemia Hypoxia Hydrogen ion (acidosis) Hyper-hypokalemia Hypoglycemia Hypothermia T’s Tension pneumothorax Tamponade Toxins Thrombosis Thrombosis