Pediatric emergency medicine trisk 1525 1525
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TABLE 77.3
LIFE-THREATENING CAUSES OF TACHYCARDIA
Sinus tachycardia
Anaphylaxis
Hypoxia
Hypoglycemia
Sepsis
Shock
Pheochromocytoma
Poisoning (see Table 63.4 )
Myocarditis
Pericardial effusion with tamponade
Cardiac
Supraventricular tachycardia
Ventricular tachyarrhythmias
Atrial flutter
EVALUATION AND DECISION
The child with tachycardia requires rapid assessment for the presence of hypoxia,
hypoglycemia, an existing life-threatening arrhythmia, or shock ( Fig. 77.1 ).
Respiratory distress with cyanosis or low pulse oximetry (less than 90%)
demands immediate provision of supplemental oxygen and further management
of airway and breathing (see Chapters 8 Airway and 99 Pulmonary Emergencies
). Hypoglycemia typically presents with tremor, anxiety/irritability, diaphoresis,
and/or altered mental status and can be confirmed by measuring rapid blood
glucose level. If an arrhythmia is suggested by an extremely rapid heart rate or a
concerning tracing on the bedside cardiac monitor, a 12-lead electrocardiogram
(EKG) and rhythm strip are necessary to confirm this impression and to guide
further treatment (see Chapter 86 Cardiac Emergencies ). Children with
congenital heart disease or a family history of sudden death are at increased risk
for a life-threatening tachyarrhythmia. Consultation with a pediatric cardiologist
and/or emergent echocardiography is warranted. In patients with shock,
additional history and physical findings may help guide the clinician. Although
the etiology may not be initially apparent, rapid treatment is imperative (see
Chapter 10 Shock ).
