PEARS Pediatric Dysrhythmia Recognition 1 — Questions and Answers
Question 1: What is the normal resting heart rate range for a 2-year-old child?
- 60-100 bpm
- 80-130 bpm (Correct answer)
- 100-190 bpm
- 140-200 bpm
Correct answer: 80-130 bpm
The normal resting heart rate for a toddler aged 1-3 years is approximately 80-130 bpm, which is higher than adult norms.
Question 2: Which ECG characteristic is most typical of supraventricular tachycardia (SVT) in children?
- Wide QRS complex with P waves before each QRS
- Narrow QRS complex at 220-300 bpm with absent or abnormal P waves (Correct answer)
- Irregular rhythm with variable RR intervals
- Prolonged PR interval with each P wave followed by a QRS
Correct answer: Narrow QRS complex at 220-300 bpm with absent or abnormal P waves
SVT in children typically presents with a narrow QRS complex, a very rapid rate (often 220-300 bpm), and P waves that are absent or hidden in the T wave.
Question 3: A 6-year-old presents with sudden palpitations and a heart rate of 230 bpm; ECG shows narrow QRS complexes with no identifiable P waves. What is the most likely rhythm?
- Sinus tachycardia
- Atrial flutter
- Supraventricular tachycardia (Correct answer)
- Ventricular tachycardia
Correct answer: Supraventricular tachycardia
SVT characteristically presents as a very rapid narrow-complex tachycardia with absent or retrograde P waves and an abrupt onset in children.
Question 4: What is the preferred vagal maneuver for SVT in an infant?
- Carotid sinus massage
- Ice water facial immersion (Correct answer)
- Eyeball pressure
- Breath-holding
Correct answer: Ice water facial immersion
Ice water facial immersion (diving reflex) is the safest and most effective vagal maneuver for infants because it does not require patient cooperation.
Question 5: What is ventricular tachycardia (VT) characterized by on ECG?
- Narrow QRS complex at a rate greater than 100 bpm
- Wide QRS complex (≥0.09 sec in children) at a rate greater than 120 bpm (Correct answer)
- Irregular rhythm with a fibrillatory baseline
- P waves without associated QRS complexes
Correct answer: Wide QRS complex (≥0.09 sec in children) at a rate greater than 120 bpm
Ventricular tachycardia is defined by a wide QRS complex (≥0.09 sec in children) at a rate greater than 120 bpm, originating from the ventricles.
Question 6: Which rhythm is characterized by chaotic, irregular electrical activity with no identifiable P waves or QRS complexes?
- Asystole
- Ventricular tachycardia
- Ventricular fibrillation (Correct answer)
- Pulseless electrical activity
Correct answer: Ventricular fibrillation
Ventricular fibrillation produces chaotic, disorganized electrical activity with no recognizable P waves or QRS complexes, resulting in no effective cardiac output.
Question 7: At what heart rate does symptomatic bradycardia with poor perfusion in a child require CPR per PEARS guidelines?
- Less than 100 bpm
- Less than 80 bpm
- Less than 60 bpm (Correct answer)
- Less than 40 bpm
Correct answer: Less than 60 bpm
PEARS/PALS guidelines specify that symptomatic bradycardia below 60 bpm with poor perfusion, despite adequate oxygenation and ventilation, requires CPR.
PEARS Pediatric Dysrhythmia Recognition 1
What is the normal resting heart rate range for a 2-year-old child?