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Welcome to the lesson on Recognizing Tachycardia. In this video, we will discuss what tachycardia means, how to recognize it, and kinds of tachycardia.

Tachycardia is defined as a heart rate greater than what is considered normal for a child’s age. Like bradycardia, tachycardia can be life-threatening if it compromises the heart’s ability to perfuse effectively.

When the heart beats too quickly, there is a shortened relaxation phase, which causes two main problems: the ventricles are unable to fill completely, so cardiac output is lowered; and the coronary arteries receive less blood, so supply to the heart is decreased.

Signs and symptoms of tachycardia include respiratory distress or failure, poor tissue perfusion (for example, low urine output), altered mental state, pulmonary edema or congestion, and weak, rapid pulse.

There are several kinds of tachycardia, and they can be difficult to differentiate in children on ECG due to the elevated heart rate. The following is a list of the kinds of tachycardia and what happens during the specific tachycardic event:

Sinus Tachycardia - normal rhythm with fast rate; is likely non-dangerous, and commonly occurs during stress or fever
Supraventricular Tachycardia - rhythm starts above the ventricles
Atrial Fibrillation - causes irregularly irregular heart rhythm
Atrial Flutter - causes a sawtooth pattern on ECG
Ventricular Tachycardia - rhythm starts in the ventricles

This concludes our lesson on Recognizing Tachycardia. Next, we will review Narrow QRS Complex.

Welcome to the lesson on Narrow QRS Complex. Pediatric tachyarrhythmias are first divided into narrow complex or wide complex tachycardia. In this video, we will discuss the narrow QRS complex tachycardias.

Narrow QRS complex tachycardias include atrial flutter, sinus tachycardia, and supraventricular tachycardia (or SVT).

Atrial flutter is an uncommon rhythm distinguished on an ECG as a sawtooth pattern. It is caused by an abnormal reentrant pathway that causes the atria to beat very quickly and ineffectively. Atrial contractions may exceed 300 bpm but not all of these will reach the AV node and cause a ventricular contraction.

Most often, as a PALS provider, you will have to distinguish between two similar narrow QRS complex tachyarrhythmias: sinus tachycardia and supraventricular tachycardia (SVT). SVT is more commonly caused by accessory pathway reentry, AV node reentry, and ectopic atrial focus.

For details and differences between sinus tachycardia and SVT, please refer to Table 17 in your corresponding PALS manual.

This concludes our lesson on Narrow QRS Complex. Next, we will review Wide QRS Complex.

Welcome to the lesson on Wide QRS Complex. In this video, we will discuss the wide QRS complex tachycardias.

Wide QRS complex tachycardias include ventricular tachycardia and unusual SVT.

Ventricular tachycardia (or VT) is uncommon in children but can be rapidly fatal. Unless the individual has a documented wide complex tachyarrhythmia, an ECG with a QRS complex greater than 0.09 seconds is VT until proven otherwise. Polymorphic VT, Torsades de pointes, and unusual SVT (SVT with wide complexes due to aberrant conduction) may be reversible, for example, magnesium for Torsades, but do not delay treatment for VT.

Any of these rhythms can devolve into ventricular fibrillation (VF). VT may not be particularly rapid (simply greater than 120 bpm) but is regular. Generally, P waves are lost during VT or become dissociated from the QRS complex. Fusion beats are a sign of VT and are produced when both a supraventricular and ventricular impulse combine to produce a hybrid
appearing QRS (or fusion beat).

This concludes our lesson on Wide QRS Complex. Next, we will review Responding to Tachycardia.

Welcome to the lesson on Responding to Tachycardia. In this video, we will discuss how to respond to tachycardic events.

The initial management of tachyarrhythmia is to assess pulse and perfusion.

First, identify and treat the underlying cause. To do so, maintain patent airway and assist breathing if necessary.

If the individual is hypoxemic, administer oxygen.

Cardiac monitor identify rhythm.

Monitor blood pressure and pulse oximetry.

Administer intravenous and intraosseous access.

Assess 12-lead ECG.

For details on drug dosages and the Pediatric Tachycardia Algorithm (that is Figure 15), please refer to your corresponding PALS manual.

This concludes our lesson on Responding to Tachycardia. Next, we will review Shock.