Paediatric ECG

Monitoring &
Interpretation
 INDICATIONS PQRST CATEGORIZING

Objectives

ALARM RESPIRATORY CASE

MANAGEMENT MONITORING SCENARIOS
 • cardiac electrophysiological status is
compromised
• risk of experiencing clinically significant changes

Clinical • risk of becoming compromised related to:

indications a) underlying cardiac or other disease

b) BPEWS score > 7
c) Risk of developing an arrhythmia
d) Pacemaker
 electrolyte imbalance

metabolic disturbance
Risks for
developing an
arrhythmia Ingestion of medications

Insertion of a guide wire for CVAD

placement
 TEMPORARY NEW PERMANENT
PACEMAKERS PACEMAKERS
Pacemaker

PACEMAKER
PROBLEMS
The electrical pathway & PQRST
 PQRST
assessment
 CAB RATE &
REGULARITY
Assessing
ECG strips

ASSESS P WAVE, ORIGIN

QRS, T WAVE
 • Circulation
• Airway
• Breathing

CAB assessment
1 month old
Rate & regularity
asleep
1 month old
P wave, QRS, T wave
asleep
1 month old
asleep
1 month old
• Normal sinus rhythm
asleep
1 month old
asleep
1 month old
• Sinus bradycardia
asleep
1 month old
crying
1 month old
• Sinus tachycardia
crying
Redo photo
sinus arrhythmia
10 year old
awake, calm
10 year old
• Pre-atrial contractions (PACs)
awake, calm
15 year old
asleep
15 year old
• Atrial flutter
asleep
13 year old
awake, calm
13 year old
• Atrial fibrillation
awake, calm
6 month old
calm
6 month old
• Supraventricular tachycardia (SVT)
calm
Newborn
calm
Newborn
• Junctional
calm
6 year old
calm
6 year old • Pre-junctional contractions (PJCs)
calm • NSR
15 year old
awake
15 year old • Pre-ventricular contractions (PVCs)
awake • NSR
11 year old
awake, calm
11 year old • PVCs
awake, calm • NSR
10 year old
awake, calm
10 year old • PVCs
awake, calm • NSR
13 year old
electrolyte imbalance
awake, calm
13 year old
electrolyte imbalance • PVCs
awake, calm
13 year old
worsening electrolyte
imbalance
13 year old
worsening electrolyte
• PVCs increased frequency
imbalance
13 year old
worsening
electrolyte
imbalance
13 year old
worsening • PVCs increased frequency
electrolyte • run of ventricular tachycardia (VT)
imbalance
16 year old
Soccer field
Syncope
16 year old
Soccer field • Ventricular tachycardia
Syncope
16 year old
Soccer field
2 min later
LOC, pulseless
16 year old
Soccer field
2 min later • Ventricular fibrillation
LOC, pulseless
Alarming
"PVCs"
Alarming
• Artifact
"PVCs"
Alarming "PVCs"
Alarming "PVCs" • Artifact
Alarming
"Couplets"
Alarming
• Artifact
"Couplets"
Alarming
"Bigeminy"
Alarming
• Artifact
"Bigeminy"
 Electrode care

• RA, LA, LL position

• Over soft tissue
• Clean with soap & water
• All same brand
• Match colours
• Replace Q24 hrs
 Electrode care

• RA, LA, LL position

• Over soft tissue
• Clean with soap & water
• All same brand
• Match colours
• Replace Q24 hrs
 • Network connection • Set alarm limits
Monitor set up
• AC power in red outlet • Admit
• Unit name • CIC connection
• Room number • Enter name
• Recall default • Assign to VAM
• Select lead II
Lead I
Lead 1
Lead II
Lead II
Lead III
Lead III
 • RR, apena

Clinical indications
Respiratory • Risk for decreased RR

monitoring • Risk for hypoventilation

• Risk for apnea
• Given sedation
Lead I Lead II
Respiratory waveform
Alarm fatigue

Safety risk Prevention

• excessive alarms • only monitor when indicated
• distract nurses from patient care • electrode care
• can cause errors • appropriate alarm limits
• Discontinue when indicated
Alarm management
Alarm management
Case A
1 month old • Alarming "PVCs"
crying
Case A
1 month old • Valid or Invalid alarm?
crying
Case A
1 month old • Invalid alarm (artifact)
crying
Case B
Newborn • Alarming "tachycardia"
crying during IV
insertion
Case B
Newborn • Valid or Invalid alarm?
crying during IV
insertion
Case B
Newborn • Valid alarm
crying during IV • Clinically significant or insignificant?
insertion
Case B
Newborn • Valid alarm
crying during IV • Clinically insignificant
insertion
Case C
15 year old
• Alarming "PVC" and "irregular"
awake
post-procedure
Case C
15 year old
• Valid or invalid alarm?
awake
post-procedure
Case C
15 year old • Valid alarm
awake • Clinically insignificant or significant?
post-procedure
Case C
15 year old • Valid alarm
awake • Clinically significant
post-procedure
Case C
15 year old • Alarming "PVCs" and "Couplets"
2 hours later
Case C
15 year old • Valid or invalid alarm?
2 hours later
Case C • Valid alarm
15 year old
2 hours later • Clinically significant or insignificant?
Case C • Valid alarm
15 year old
2 hours later • Clinically significant