TY - CHAP M1 - Book, Section TI - Arrhythmias A1 - Rozenfeld, Ranna A. PY - 2018 T2 - The PICU Handbook AB - Electrocardiograms (ECGs) of normal infants and children are different from those of normal adults. Neonates and infants will demonstrate right ventricular (RV) dominance related to the relative hypertrophy of the RV caused by the fetal circulation. Left ventricular (LV) dominance develops over the course of childhood. Sequence of Interpretation: Specific order is less important than having your own systematic approach to rhythm interpretation (Figure 33-1). Here is one example: Rate: Heart rate Clinical Tip: Estimated HR = 300 / # of big boxesRhythm: Sinus or nonsinusClinical Tip: Normal sinus rhythm requires the presence of:P before every QRSRegular PR intervalNL P wave axis (0–90 degrees) – P wave upright in I and aVFAxes: QRS axis, T wave axis. An upright wave in any given lead means the vector forces travel towards that lead.Intervals: Measure the PR, QRS, QTc intervalsMorphology: P wave amplitude and duration, QRS amplitude and duration, presence of abnormal Q waves, ST and T wave morphologyTelemetry: Continuous monitoring of the cardiac rhythm is standard of care in the cardiac intensive care unit (CICU)Cardiac monitoring is used to identify pathologic rhythms in patients at risk for arrhythmia.Real-time cardiac monitoring is not an ECG. Full interpretation of axis and morphology cannot be performed due to differences in electrode positioning compared to standard 12-lead ECG.Continuous cardiac monitoring is indicated in patients who have undergone cardiac surgery; have a history of heart failure or arrhythmias; or have been admitted to the ICU for major trauma, acute respiratory failure, shock, pulmonary embolus, renal failure with electrolyte abnormalities, or toxic ingestion. Also used for monitoring in patients receiving proarrhythmic medications. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accesspediatrics.mhmedical.com/content.aspx?aid=1152487972 ER -