Pediatric emergency medicine trisk 0194 0194
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FIGURE 9.1 Pathophysiologic pathways from etiologies to cardiac arrest.
Arrhythmia management is a relatively infrequent problem in pediatric life
support. The absence of atherosclerotic vascular disease makes the child’s
myocardium less susceptible to arrhythmias, and a minority of arrested children
present with a shockable rhythm. As a result, antiarrhythmic medications and
defibrillation are infrequently used. The most common cardiac rhythms to be
recognized and managed in pediatric arrest are sinus bradycardia, pulseless
electrical activity (PEA), and asystole. The exceptions to this are those children
with congenital heart disease and those who have sustained direct myocardial
trauma (see Chapter 86 Cardiac Emergencies ). These children may have unusual
and difficult arrhythmias that require subspecialist expertise to achieve a
successful outcome.
Finally, there is still much to be learned about caring for children requiring
resuscitation. The creation of research networks and CPR registries has greatly
expanded the possibility for prospective, large, multicenter trials. Exemption from
informed consent is an evolving concept in studies of children with a life-
