Pediatric EKG
Tuesday Noon Teaching Session
Developed 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
Axis
Intervals
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 Leads
Adapted from: www.numed.co.uk/electrodepl.html
The End
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.