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Pediatric ECG - Coggle Diagram

- - - - Hyperkalemia: Peaked T wave = greater than 6mEQ/L K
      - Hypokalemia: Flat T wave = less than 3 mEq/L K
    - - High: shorten QT
      - Low: prolonge QT
  - - - orthosyndromic (circular one direction rhythm with a one directional pathway)
      - WPW (bidirectional accessory pathway)
        
        risk of vtach and sudden death, requires ablation in cath lab
- - - - 5 little box = big box = 0.2 sec
      - little box = 0.04 second
  - - - Look for largest P wave in limb lead and note angle (remember P is atrial depolarization from high to low and left to right)
        
        confirm that leads at right angles are isoelectric
    - - Look for largest QRS wave and note angle
        
        look for isoelectric leads at right angles
  - - - If long (congenital QT prolongation syndrome vs drug vs electrolyte abnormality), can be cause of fatal arrhythmia
  - - - particular balance of forces in V1 and V6
        
        V6: R wave greater than S wave
        
        V1: S wave greater than R wave (electricity move away at first)
        
        Look for bundle branch in V1
  - - - if PR interval the same but different rate between beats, and no dropped beats, the "sinus arrhythmia" which is a physiologic finding
- - - - depolarization to threshold potential to action potential leads to flood of positive charge into cell
        
        fast response of sodium channel in atrial muscle, ventricular muscle, his-purkinje cells (depolarize stage 0)
        
        plateau (stage 2), repolarize stage 3
        
        slow response or calcium channel in SA node, AV node, use calcium to depolarize
        
        they depolarize automatically, leading to automaticity (and pasemaker)
  - - - depolarize (phase 0) right atrium and then left atrium (p wave)
        
        when atrial cells enter plateau (stage 2), p wave complete
        
        when depolarization reaches lower right atrium, depolarization of AV node is initiated, depolarize slowly
        
        common bundle of His -> His-Purkinje system, fast depolarization
        
        ventricular depolarization (LV endocardium, apex, epicardium, last base of right ventricular outflow tract) -> phase 0
        
        ST segment when venciular cells reach phase 2 plateau
        
        1 more item...
  - - - Q wave: septal depolarization (right and downward)
      - R wave: left apex depolarization (left and downward)
      - S wave: depolarization of left base and RVOT (upward and rightward)
- - - - short: WPR
      - long: AV block (vagal tone, digoxin, av node disease)
    - - Left side leads: small Q, large R, small S
      - Right side leads: small R and deep S
      - Evaluate age appropriate amplitude
      - V1 QRS: 0.08 infant, 0.10 over 6 months
        
        prolongation: bundle branche block, myocyte conduction abnormality, venticular hypertrophy
    - - frontal plane: follow QRS
      - precordial right chest
        
        under 7 days and adolescent: upright T
        
        infant and child: inverted T
      - precordial left chest
        
        follows QRS