Pediatric emergency medicine trisk 1528 1528
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undergo a pericardial drainage procedure (e.g., placement of a pericardial catheter
percutaneously under ultrasound guidance and/or pericardial window procedure).
Acute rheumatic fever follows pharyngeal streptococcal infection and is an
inflammatory disease that targets the heart, vessels, joints, skin, and central
nervous system (CNS). Diagnosis and management of acute rheumatic fever are
discussed separately (see Chapter 86 Cardiac Emergencies ). Clinical criteria for
Kawasaki disease consist of prolonged high fever, conjunctivitis with perilimbic
sparing, “strawberry tongue,” painful swelling of the hands and feet, rash, and
lymphadenopathy. Early recognition and treatment of Kawasaki disease with
intravenous γ-globulin is necessary to prevent the development of coronary artery
aneurysms with potential for myocardial ischemia (see Chapter 101
Rheumatologic Emergencies ).
Patients with thyroid storm may have marked sinus tachycardia, fever, goiter,
and CNS stimulation (agitation, delirium, psychosis, seizures) accompanied by
congestive heart failure (see Chapter 89 Endocrine Emergencies ). Trauma,
thyroid infection, thyroid surgery, and acute iodine load are frequent precipitants.
Rapid recognition and institution of therapy to treat adrenergic symptoms (βadrenergic blockers), block hormone synthesis (methimazole), prevent peripheral
conversion of T4 to T3 (iodinated radiocontrast agents), and prevent thyroid
hormone release (iodine) are necessary to prevent mortality.
Crying, pain, or anxiety is the most frequent cause of sinus tachycardia in
afebrile children. Drug ingestion, poisoning, and anemia are important additional
considerations (see Table 63.4 ). Rarely, sinus tachycardia may herald the
presence of hyperthyroidism or pheochromocytoma, a catecholamine-secreting
tumor that causes extreme hypertension, diaphoresis, and flushing (see Chapter
89 Endocrine Emergencies ).
Suggested Readings and Key References
American Heart Association. Pediatric Advanced Life Support Provider Manual .
Dallas, TX: American Heart Association; 2016.
Fleming S, Thompson M, Stevens R, et al. Normal ranges of heart rate and
respiratory rate and respiratory rate in children from birth to 18 years of age: a
systematic review of observational studies. Lancet 2011;377:1011–1018.
Fuchs S, Yamamoto L, eds. APLS: The Pediatric Emergency Medicine Resource .
5th ed. Burlington, MA: Jones & Bartlett Learning; 2012.
Mazor S, Mazor R. Approach to the child with tachycardia. UpToDate . Available
online at www.uptodate.com . Accessed April 18, 2019.
