Arrhythmias

Question 1

Child has unstable ventricular tachycardia with evidence of hemodynamic compromise. What is the treatment and dose?

Answer 1

Electric cardioversion

Start with 1J/kg and increase to 2J if needed

Question 2

What is the cause, treatment, and dose for pediatric torsades de pointes?

Answer 2

Torsades is caused by prolonged QT
Treatment is rapid infusion of magnesium
Dose is 25 to 50mg/kg over several minutes with max dose 2g

Question 3

How does adenosine work and what is its primary use?
What other arrhythmias can it be used for in stable kids?
Dose?

Answer 3

Short acting AV nodal blocker making it most useful for stable supra-ventricular tachycardias
Also used for stable wide-complex ventricular tachycardia in kids
Dose: 0.1mg/kg with max 6mg, repeat dose can be doubled

Question 4

What is the treatment for kids with stable ventricular tachycardia? Dose? Adverse effects and cautions for use.

Answer 4

Amiodarone can be given
Dose: 5mg/kg infused over 20–60 minutes
Adverse: hypotension, QT prolongation, bradycardia
Caution: only give with consultation from ped. cardiologist

Question 5

What is the treatment for kids with pulseless ventricular tachycardia? Dose?

Answer 5

Defibrillation

Dose: 2J/kg then 4J if needed

Question 6

If you have a wide complex tachycardia and don’t know what it is, how should it be managed?

Answer 6

Like a ventricular tachycardia

Question 7

Why is ventricular tachycardia significant?

Answer 7

Some forms lead to lack of a pulse
Causes poor cardiac perfusion leading to deterioration into ventricular fibrillation and eventual death
Must be treated!