PALS Precourse Self-Assessment
ECG Rhythm Identification Answer Sheet
PediatricwdRhythmswd(corewdPALSwdrhythmswdAwdtowdH;wdnon-corewdrhythmswdIwdtowdM):
A. Normalwdsinuswdrhythm
B. Sinuswdtachycardia
C. Sinuswdbradycardia
D. Supraventricularwdtachycardiawd(SVT)
E. Wide-complexwdtachycardia;wdpresumedwdventricularwdtachycardiawd(monomorphic)
F. Ventricularwdfibrillationwd(VF)
G. Asystole
H. Pulselesswdelectricalwdactivitywd(PEA)
I. SVTwdconvertingwdtowdsinuswdrhythmwdwithwdadenosinewdadministration
J. Wide-
complexwdtachycardiawd(inwdawdchildwdwithwdknownwdaberrantwdintraventricularwdconduction
;wdthiswdiswdSVTwdwithwdaberrantwdconduction)
K. First-degreewdAVwdblock
L. Torsadeswddewdpointeswd(polymorphicwdventricularwdtachycardia)
M. VFwdconvertedwdtowdorganizedwdrhythmwdafterwdsuccessfulwdshockwddeliverywd(defibrilla
tion)wdRhythmswd1wdtowd8:wdCorewdPALSwdRhythmswd(selectwdsinglewdbestwdanswerwdfromwdrh
ythmswdAwdtowdH)
Rhythmwd1wd(clinicalwdclue:wdheartwdratewd214/min)
CorrectwdanswerwdiswdE:wdWide-
complexwdtachycardia;wdpresumedwdventricularwdtachycardiawd(monomorphic)
PediatricwdECGwdtip:wdVentricularwdtachycardiawdiswdawdsustainedwdserieswdofwdwidewdQRSwdco
mplexeswd(ie,wdventricularwddepolarizations)wdtypicallywdatwdawdratewdofwdatwdleastwd120/min.wdTh
PALSwdWrittenwd2006wdPrecoursewdSelf- 28
Assessment
© 2006 American Heart Association
, iswdVTwdcanwdbewdfurtherwdclassifiedwdaswdmonomorphicwdbecausewdallwdcomplexeswdhavewdthe
wdsamewdappearance.wdIf
PALSwdWrittenwd2006wdPrecoursewdSelf- 29
Assessment
© 2006 American Heart Association
, thiswdrhythmwdiswdobservedwdinwdawdchildwdwithwdnowdhistorywdofwdaberrantwdintraventricularwdco
nductionwdandwdnowdaberrantwdconductionwdapparentwdonwd12-
leadwdECG,wdthewdrhythmwdshouldwdbewdpresumedwdtowdbewdventricularwdtachycardia.
Forwdfurtherwdinformation:wdseewdthewdPALSwdProviderwdManualwdChapterwd6:wdRec
ognitionwdandwdManagementwdofwdBradyarrhythmiaswdandwdTachyarrhythmiaswdan
dwdChapterwd7:wdRecognitionwdandwdManagementwdofwdCardiacwdArrest.
Rhythmwd2wd(clinicalwdclues:wdheartwdratewd44/min;wdnowddetectablewdpulses)
CorrectwdanswerwdiswdH:wdPulselesswdelectricalwdactivitywd(PEA)
PediatricwdECGwdtip:wdInwdthewdabsencewdofwddetectablewdpulses,wdthiswdorganizedwdrhythmwdis
wdonewdof wdthewdcardiacwdarrestwdrhythms—
Pulselesswdelectricalwdactivitywd(PEA)wd(PEA).wdItwdiswdtreatedwdusingwdthewdasystole/PEAwdpor
tionwdofwdthewdPALSwdPulselesswdArrestwdalgorithm.wdThiswdparticularwdrhythmwdmaywdbewddesc
ribedwdaswdanwdidioventricularwdescapewdrhythmwd(anwdescapewdrhythmwdoriginatingwdfromwdawd
slowwdventricularwdpacemakerwdduringwdperiodswdofwdsignificantwdsinuswdbradycardiawdorwdhig
h-
gradewdAVwdblock).wdItwdiswdcharacterizedwdbywdwidewdQRSwdcomplexes,wdandwditwdiswdoftenwdse
enwdinwdthewdsettingwdofwdawdseverelywdhypoxic-ischemicwdmyocardium.
Forwdfurtherwdinformation:wdseewdthewdPALSwdProviderwdManualwdChapterwd6:wdRec
ognitionwdandwdManagementwdofwdBradyarrhythmiaswdandwdTachyarrhythmias.
PALSwdWrittenwd2006wdPrecoursewdSelf- 30
Assessment
© 2006 American Heart Association
, Rhythmwd3wd(clinicalwdclues:wdagewd8wdyears;wdheartwdratewd50/min)
CorrectwdanswerwdiswdC:wdSinuswdbradycardia.
PediatricwdECGwdtip:wdSinuswdbradycardiawdiswdcharacterizedwdbywdawdsinuswdrhythmwdwithwdaw
iswdslowerwdthanwdnormalwdforwdthewdpatient’swdage.wdPwdwaveswdandwdQRSwdcompl
dratewdthatw
d
exeswdarewdusuallywdnormalwdinwdappearance;wdthewdQRSwdiswdnarrow.
Forwdfurtherwdinformation:wdseewdthewdPALSwdProviderwdManualwdChapterwd6:wdRec
ognitionwdandwdManagementwdofwdBradyarrhythmiaswdandwdTachyarrhythmias.
Rhythmwd4wd(clinicalwdclue:wdnowddetectablewdpulses)
CorrectwdanswerwdiswdG:wdAsystole
PediatricwdECGwdtip:wdAsystolewdiswdthewdabsencewdofwdventricularwddepolarizationwd(ie,wdcar
diacwdstandstill).wdItwdmaywdbewdprecededwdbywdanwdagonalwd(usuallywdwide-
complex)wdbradyarrhythmiawd(seewdanwdexamplewdofwdthiswdinwdRhythmwd2).wdWhenwdyouwdo
bservewdthiswdrhythmwdinwdawdchildwdwhowdiswdunresponsive,wdapneic,wdandwdpulseless,wdyouwd
shouldwdbeginwdcompressionswdandwdventilationswd(CPR)wdimmediately.wdOfwdcourse,wdifwdyo
uwdarewduncertainwdwhetherwdthewdrhythmwdiswdasystole,wdconfirmwdthewdflat-
linewdrhythmwdinwd2wdperpendicularwdleadswdbutwddowdnotwddelaywdCPRwdforwdanwdunresponsi
ve,wdapneicwdchild.
PALSwdWrittenwd2006wdPrecoursewdSelf- 31
Assessment
© 2006 American Heart Association
ECG Rhythm Identification Answer Sheet
PediatricwdRhythmswd(corewdPALSwdrhythmswdAwdtowdH;wdnon-corewdrhythmswdIwdtowdM):
A. Normalwdsinuswdrhythm
B. Sinuswdtachycardia
C. Sinuswdbradycardia
D. Supraventricularwdtachycardiawd(SVT)
E. Wide-complexwdtachycardia;wdpresumedwdventricularwdtachycardiawd(monomorphic)
F. Ventricularwdfibrillationwd(VF)
G. Asystole
H. Pulselesswdelectricalwdactivitywd(PEA)
I. SVTwdconvertingwdtowdsinuswdrhythmwdwithwdadenosinewdadministration
J. Wide-
complexwdtachycardiawd(inwdawdchildwdwithwdknownwdaberrantwdintraventricularwdconduction
;wdthiswdiswdSVTwdwithwdaberrantwdconduction)
K. First-degreewdAVwdblock
L. Torsadeswddewdpointeswd(polymorphicwdventricularwdtachycardia)
M. VFwdconvertedwdtowdorganizedwdrhythmwdafterwdsuccessfulwdshockwddeliverywd(defibrilla
tion)wdRhythmswd1wdtowd8:wdCorewdPALSwdRhythmswd(selectwdsinglewdbestwdanswerwdfromwdrh
ythmswdAwdtowdH)
Rhythmwd1wd(clinicalwdclue:wdheartwdratewd214/min)
CorrectwdanswerwdiswdE:wdWide-
complexwdtachycardia;wdpresumedwdventricularwdtachycardiawd(monomorphic)
PediatricwdECGwdtip:wdVentricularwdtachycardiawdiswdawdsustainedwdserieswdofwdwidewdQRSwdco
mplexeswd(ie,wdventricularwddepolarizations)wdtypicallywdatwdawdratewdofwdatwdleastwd120/min.wdTh
PALSwdWrittenwd2006wdPrecoursewdSelf- 28
Assessment
© 2006 American Heart Association
, iswdVTwdcanwdbewdfurtherwdclassifiedwdaswdmonomorphicwdbecausewdallwdcomplexeswdhavewdthe
wdsamewdappearance.wdIf
PALSwdWrittenwd2006wdPrecoursewdSelf- 29
Assessment
© 2006 American Heart Association
, thiswdrhythmwdiswdobservedwdinwdawdchildwdwithwdnowdhistorywdofwdaberrantwdintraventricularwdco
nductionwdandwdnowdaberrantwdconductionwdapparentwdonwd12-
leadwdECG,wdthewdrhythmwdshouldwdbewdpresumedwdtowdbewdventricularwdtachycardia.
Forwdfurtherwdinformation:wdseewdthewdPALSwdProviderwdManualwdChapterwd6:wdRec
ognitionwdandwdManagementwdofwdBradyarrhythmiaswdandwdTachyarrhythmiaswdan
dwdChapterwd7:wdRecognitionwdandwdManagementwdofwdCardiacwdArrest.
Rhythmwd2wd(clinicalwdclues:wdheartwdratewd44/min;wdnowddetectablewdpulses)
CorrectwdanswerwdiswdH:wdPulselesswdelectricalwdactivitywd(PEA)
PediatricwdECGwdtip:wdInwdthewdabsencewdofwddetectablewdpulses,wdthiswdorganizedwdrhythmwdis
wdonewdof wdthewdcardiacwdarrestwdrhythms—
Pulselesswdelectricalwdactivitywd(PEA)wd(PEA).wdItwdiswdtreatedwdusingwdthewdasystole/PEAwdpor
tionwdofwdthewdPALSwdPulselesswdArrestwdalgorithm.wdThiswdparticularwdrhythmwdmaywdbewddesc
ribedwdaswdanwdidioventricularwdescapewdrhythmwd(anwdescapewdrhythmwdoriginatingwdfromwdawd
slowwdventricularwdpacemakerwdduringwdperiodswdofwdsignificantwdsinuswdbradycardiawdorwdhig
h-
gradewdAVwdblock).wdItwdiswdcharacterizedwdbywdwidewdQRSwdcomplexes,wdandwditwdiswdoftenwdse
enwdinwdthewdsettingwdofwdawdseverelywdhypoxic-ischemicwdmyocardium.
Forwdfurtherwdinformation:wdseewdthewdPALSwdProviderwdManualwdChapterwd6:wdRec
ognitionwdandwdManagementwdofwdBradyarrhythmiaswdandwdTachyarrhythmias.
PALSwdWrittenwd2006wdPrecoursewdSelf- 30
Assessment
© 2006 American Heart Association
, Rhythmwd3wd(clinicalwdclues:wdagewd8wdyears;wdheartwdratewd50/min)
CorrectwdanswerwdiswdC:wdSinuswdbradycardia.
PediatricwdECGwdtip:wdSinuswdbradycardiawdiswdcharacterizedwdbywdawdsinuswdrhythmwdwithwdaw
iswdslowerwdthanwdnormalwdforwdthewdpatient’swdage.wdPwdwaveswdandwdQRSwdcompl
dratewdthatw
d
exeswdarewdusuallywdnormalwdinwdappearance;wdthewdQRSwdiswdnarrow.
Forwdfurtherwdinformation:wdseewdthewdPALSwdProviderwdManualwdChapterwd6:wdRec
ognitionwdandwdManagementwdofwdBradyarrhythmiaswdandwdTachyarrhythmias.
Rhythmwd4wd(clinicalwdclue:wdnowddetectablewdpulses)
CorrectwdanswerwdiswdG:wdAsystole
PediatricwdECGwdtip:wdAsystolewdiswdthewdabsencewdofwdventricularwddepolarizationwd(ie,wdcar
diacwdstandstill).wdItwdmaywdbewdprecededwdbywdanwdagonalwd(usuallywdwide-
complex)wdbradyarrhythmiawd(seewdanwdexamplewdofwdthiswdinwdRhythmwd2).wdWhenwdyouwdo
bservewdthiswdrhythmwdinwdawdchildwdwhowdiswdunresponsive,wdapneic,wdandwdpulseless,wdyouwd
shouldwdbeginwdcompressionswdandwdventilationswd(CPR)wdimmediately.wdOfwdcourse,wdifwdyo
uwdarewduncertainwdwhetherwdthewdrhythmwdiswdasystole,wdconfirmwdthewdflat-
linewdrhythmwdinwd2wdperpendicularwdleadswdbutwddowdnotwddelaywdCPRwdforwdanwdunresponsi
ve,wdapneicwdchild.
PALSwdWrittenwd2006wdPrecoursewdSelf- 31
Assessment
© 2006 American Heart Association
