Reading and Interpreting
EKG
T Petrillo-Albarano, MD
Division of Pediatric Critical Care
Children’s Healthcare of Atlanta
The EKG

P wave
– Depolarization atria

QRS
– Depolarization ventricle

T wave
– Repolarization Ventricle
EKG (pic of QRS)
Normal Rates
O-3 months
 3m-2years
 2-10years
 > 10years

85-205 (140)
100-190 (130)
60-140 (80)
60-100 (75)
Determining Rates (counting
boxes)
Identifying Rhythm

Too Slow
– bradycardia

Too Fast
– tachycardia

Absent
– Pulseless arrest
Bradycardia (strip)
Bradycardia
HR less than 60
 Associated with poor perfusion
 Can be caused by many factors

– Hypotension, hypoxemia, acidosis, ingestion

In children Hypoxemia is often culprit
– Support the airway
Bradycardia Algorithm
Tachy-arrhythmias

ABC
– Adequate airway
– Respiratory effort

Does the child have a pulse?
– No Pulse: CPR; define rhythm
– Positive pulse.. Define rhythm
 Assess QRS duration
Sinus Tachycardia

Causes?
– Hypovolemia
– Fever
– Anxiety
– Pain
– Metabolic stressors
– drugs
Sinus Tachycardia
P waves present and normal
 Variability to rate
 Constant PR interval
 Infants usually less than 220; children
usually less than 180


Treat the cause
Sinus Tachycardia (strip)
Supra-ventricular Tachycardia
Usual sudden onset
 No history to support ST
 P waves are often absent ( but can be
present)
 Abrupt changes
 Usually greater than 220 or 180

SVT
Assess Perfusion
 Good perfusion:

– Call cardiology
– Vagal maneuvers
– Adenosine

Poor perfusion
– Cardioversion
– Adenosine
– Beta blockers
SVT (strip)
V Tach with pulse
Most will have underlying congenital heart
disease or myocarditis/ cardiomyopathy
 Can be related to electrolyte imbalance,
toxin, drugs

Cardioversion
 Consider Amiodirone

V Tach
Tachycardia Algorithm
Pulseless Rhythms
VT
 V-fib
 PEA
 Asystole

V Fib
V Tach
PEA
Asystole
Pulseless Algorithm