Pediatric EKGPediatric EKGTuesday Noon Teaching SessionDeveloped by Dr. Lisa Lemieux

Original slides courtesy of Dr. Lindsay Long(adapted)

Tuesday Noon Teaching SessionDeveloped by Dr. Lisa Lemieux

Original slides courtesy of Dr. Lindsay Long(adapted)

Learning Objectives

Basic Approach to Pediatric EKGs

Rhythm recognition

How to use the EKG machine

Learning Objectives

Basic Approach to Pediatric EKGs

Rhythm recognition

How to use the EKG machine

Approach to EKG interpretation:

Rate Rhythm

AxisIntervals

Ups and Downs

Approach to EKG interpretation:

Rate Rhythm

AxisIntervals

Ups and Downs

What are some challenges to interpreting Pediatric

EKG’s?

What are some challenges to interpreting Pediatric

EKG’s?

• age-related changes -- such as?

• movement artifact

Take a look at the settings

• Standard amplitude is ___ mm/mV

• Paper speed is ___ mm/s

Double-check the settings

• Standard amplitude is 10 mm/mV

• Paper speed is 25 mm/s

Waveforms and Intervals

Rate

Dubin, D. Rapid Interpretation of EKG’s. 6th Edition. Tampa, FL: Cover Publishing; 2000: 80-84.

Rate

Dubin, D. Rapid Interpretation of EKG’s. 6th Edition. Tampa, FL: Cover Publishing; 2000: 80-84.

Rate

Dubin, D. Rapid Interpretation of EKG’s. 6th Edition. Tampa, FL: Cover Publishing; 2000: 80-84.

Rate

Dubin, D. Rapid Interpretation of EKG’s. 6th Edition. Tampa, FL: Cover Publishing; 2000: 80-84.

Rate

Dubin, D. Rapid Interpretation of EKG’s. 6th Edition. Tampa, FL: Cover Publishing; 2000: 80-84.

Rate

Dubin, D. Rapid Interpretation of EKG’s. 6th Edition. Tampa, FL: Cover Publishing; 2000: 80-84.

Rate

Dubin, D. Rapid Interpretation of EKG’s. 6th Edition. Tampa, FL: Cover Publishing; 2000: 80-84.

Rhythm

• What defines a sinus rhythm? P wave before every QRS QRS after every P wave

‣ Normal PR interval for age Normal P wave axis Upright I and aVF

Rhythm

• What defines a sinus rhythm? P wave before every QRS QRS after every P wave Normal PR interval for age

Axis

Which quadrant represents a “normal” QRS axis in an adult?

Where would you see Left Axis Deviation?

Left Axis Deviation

What would this be?

Extreme Right Axis Deviation

And this?

Right Axis Deviation

Axis• QRS axis is usually directed

toward a hypertrophied ventricle

‣ What is the expected axis in a newborn?

Axis

• What is the expected axis in a newborn?

Large R ventricle = Right axis deviation

Normal neonatal EKG in a 1-week-old infant. QRS axis is 125°, which would be considered right axis deviation in an adult. Note the tall R waves in V1, V2, and V3, which are normal.

O’Connor, M., McDaniel, N., Brady, W. The Pediatric Electrocardiogram Part I: Age-related Interpretation. American Journal of Emergency Medicine (2008) 26, 221–228

Ups and Downs: Look at ST segment, T wave progression, ?extra blips (U waves, etc)

Learning Objectives

Basic Approach to Pediatric EKGs

• systematic approach

• refer to tables with age-related values

Rhythm recognition

How to use the EKG machine

Learning Objectives

Basic Approach to Pediatric EKGs

• systematic approach

• refer to tables with age-related values

Rhythm recognition

How to use the EKG machine

Precordial LeadsPrecordial Leads

Adapted from: www.numed.co.uk/electrodepl.html

The EndThe EndAny questions?Any questions?

References• Chan, T., Sharieff, G., Brady, W. Electrocardiographic

Manifestations: Pediatric EKG. Journal of Emergency Medicine. 35(4):421–430

• Dubin, D. Rapid Interpretation of EKG’s. 6th Edition. Tampa, FL: Cover Publishing; 2000: 80-84.

• O ’Connor, M., McDaniel, N., Brady, W. The Pediatric Electrocardiogram Part I: Age-related Interpretation. American Journal of Emergency Medicine (2008) 26, 221–228

• Sharieff GQ, Rao SO. The pediatric EKG. Emerg Med. Clin North Am 2006;24:196.

• Pediatric Advanced Life Support, 2006 Edition.

• Wathen JE, Rewers AB, Yetman AT, et al. Accuracy of EKG interpretation in the pediatric emergency department. Ann Emerg Med. 2005;46:507-11.