PALS Self-Assessment | ECG Rhythm Identification Answer Sheet 2024

PALS Self-Assessment | ECG Rhythm Identification Answer Sheet 2024. Pediatric Rhythms (core PALS rhythms A to H; non-core rhythms I to M): A. Normal sinus rhythm B. Sinus tachycardia C. Sinus bradycardia D. Supraventricular tachycardia (SVT) E. Wide-complex tachycardia; presumed ventricular tachycardia (monomorphic) F. Ventricular fibrillation (VF) G. Asystole H. Pulseless electrical activity (PEA) I. SVT converting to sinus rhythm with adenosine administration J. Wide-complex tachycardia (in a child with known aberrant intraventricular conduction; this is SVT with aberrant conduction) K. First-degree AV block L. Torsades de pointes (polymorphic ventricular tachycardia) M. VF converted to organized rhythm after successful shock delivery (defibrillation) Rhythms 1 to 8: Core PALS Rhythms (select single best answer from rhythms A to H) Rhythm 1 (clinical clue: heart rate 214/min) Correct answer is E: Wide-complex tachycardia; presumed ventricular tachycardia (monomorphic) Pediatric ECG tip: Ventricular tachycardia is a sustained series of wide QRS complexes (ie, ventricular depolarizations) typically at a rate of at least 120/min. This VT can be further classified as monomorphic because all complexes have the same appearance. If 29 this rhythm is observed in a child with no history of aberrant intraventricular conduction and no aberrant conduction apparent on 12-lead ECG, the rhythm should be presumed to be ventricular tachycardia. For further information: see the PALS Provider Manual Chapter 6: Recognition and Management of Bradyarrhythmias and Tachyarrhythmias and Chapter 7: Recognition and Management of Cardiac Arrest. Rhythm 2 (clinical clues: heart rate 44/min; no detectable pulses) Correct answer is H: Pulseless electrical activity (PEA) Pediatric ECG tip: In the absence of detectable pulses, this organized rhythm is one of the cardiac arrest rhythms—Pulseless electrical activity (PEA) (PEA). It is treated using the asystole/PEA portion of the PALS Pulseless Arrest algorithm. This particular rhythm may be described as an idioventricular escape rhythm (an escape rhythm originating from a slow ventricular pacemaker during periods of significant sinus bradycardia or high-grade AV block). It is characterized by wide QRS complexes, and it is often seen in the setting of a severely hypoxic-ischemic myocardium. For further information: see the PALS Provider Manual Chapter 6: Recognition and Management of Bradyarrhythmias and Tachyarrhythmias. 30 Rhythm 3 (clinical clues: age 8 years; heart rate 50/min) Correct answer is C: Sinus bradycardia. Pediatric ECG tip: Sinus bradycardia is characterized by a sinus rhythm with a rate that is slower than normal for the patient’s age. P waves and QRS complexes are usually normal in appearance; the QRS is narrow. For further information: see the PALS Provider Manual Chapter 6: Recognition and Management of Bradyarrhythmias and Tachyarrhythmias. Rhythm 4 (clinical clue: no detectable pulses) Correct answer is G: Asystole Pediatric ECG tip: Asystole is the absence of ventricular depolarization (ie, cardiac standstill). It may be preceded by an agonal (usually wide-complex) bradyarrhythmia (see an example of this in Rhythm 2). When you observe this rhythm in a child who is unresponsive, apneic, and pulseless, you should begin compressions and ventilations (CPR) immediately. Of course, if you are uncertain whether the rhythm is asystole, confirm the flat-line rhythm in 2 perpendicular leads but do not delay CPR for an unresponsive, apneic child. 31 For further information: see the PALS Provider Manual Chapter 7: Recognition and Management of Cardiac Arrest. Rhythm 5 (clinical clue: no consistent heart rate detected; no detectable pulses) Correct answer is F: Ventricular fibrillation Pediatric ECG tip: Ventricular fibrillation (VF) is characterized by a rapid, irregular waveform of varying size and configuration. VF begins as a coarse, irregular deflection and then deteriorates to a fine, irregular pattern. If no CPR and no shocks are provided, this rhythm will eventually progress to asystole. For further information: see the PALS Provider Manual Chapter 7: Recognition and Management of Cardiac Arrest. Rhythm 6 (clinical clues: age 3 years; heart rate 188/min) Correct answer is B: Sinus tachycardia Pediatric ECG tip: Sinus tachycardia is characterized by a normal sequence of impulse 32 formation and conduction with a rate faster than normal for the patient’s age. P waves precede each QRS complex; the QRS is typically narrow. For further information: see the PALS Provider Manual Chapter 6: Recognition and Management of Bradyarrhythmias and Tachyarrhythmias. Rhythm 7 (clinical clue: heart rate 300/min) Correct answer is D: Supraventricular tachycardia Pediatric ECG tip: Supraventricular tachycardia is characterized by the following: no beat-to-beat variability with activity or stimulation; heart rate typically 220/min in infants and 180/min in children; absent or abnormal P waves; and usually narrow QRS complexes. Wide-complex tachycardia with poor perfusion is probably ventricular in origin, but one pediatric case series and clinical experience note that it may be supraventricular with aberrant intraventricular conduction. For further information: see the PALS Provider Manual Chapter 6: Recognition and Management of Bradyarrhythmias and Tachyarrhythmias. 33 Rhythm 8 (clinical clues: age 8 years; heart rate 75/min) Correct answer is A: Normal sinus rhythm Pediatric ECG tip: All rhythms originating in the sinoatrial (sinus) node are characterized by the following: P waves preceding each QRS complex; regular PR interval; all of the P waves are upright and have the same appearance. The QRS complexes are narrow in this strip. In normal sinus rhythm, the heart rhythm is regular, heart rate is normal for the patient’s age, and the rate changes with activity. Rhythms 9 to 13: Non-core Rhythms