Pediatric emergency medicine trisk 1731 1731
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condition and should be evaluated by a cardiologist.
Management/Diagnostic Testing of Wide Complex VT. The EM provider must be
able to identify, record, and treat VT in the pediatric population. Generally, wide
complex tachycardia is assumed to be VT, although a few other rhythms may
look wide. For the differential diagnosis, see Table 86.7 and Figure 86.6 .
The first step is to assess hemodynamic stability. If the patient is unstable,
management is straightforward, with rapid defibrillation and attention to ABC’s.
The energy dose for defibrillation is 2 J/kg increasing to 4 J/kg, if necessary.
Synchronize if VT is organized or monomorphic. Do not synchronize
defibrillation of VF. If at all possible, an EKG should be performed before,
during, and after conversion. The origin of VT may be discerned from the
morphology of the QRS on EKG. This information will be useful in long-term
management of the dysrhythmia.
TABLE 86.7
DIFFERENTIAL DIAGNOSIS FOR WIDE COMPLEX TACHYCARDIA
Differential diagnosis Description
Ventricular
P waves slower and not related to QRS, although they
tachycardia
may be conducted retrograde
Sinus tachycardia with Frequently seen in postoperative CHD
BBB
SVT with aberrancy
Usually aberrant for several beats and then narrows
(functional BBB)
Wolff–Parkinson–
Ventricular pre-excitation: usually seen in sinus rhythm.
White
If tachycardia is pre-excited and irregular, do not
give adenosine
Electrolyte
P waves precede QRS and rate is not fast
disturbance/acidosis
Myocardial infarction ST segment changes progress to VT or BBB associated
with MI
BBB, bundle branch block; CHD, congenital heart disease; SVT, supraventricular tachycardia; VT,
ventricular tachycardia; MI, myocardial infarction.
If wide complex tachycardia is hemodynamically stable and regular, IV access
may be obtained and a dose of adenosine administered. Some forms of SVT
