Pediatric emergency medicine trisk 1732 1732
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appear wide and will respond to adenosine.
Conversely, some VT in children is relatively narrow. See Figures 86.7 and
86.8 .
Management/Diagnostic Testing of Channelopathies. Long QT presents as
syncope due to torsades de pointes (TdP). CPR and airway management are
instituted. Defibrillation is rapidly performed. If patient continues to go back into
TdP, magnesium sulfate can be given, 30 to 50 mg/kg/dose over 5 to 20 minutes.
For adults a dose of 1 to 2 g over 5 to 20 minutes, followed by a drip of 0.5 to 1
g/hr may be used. Isoproterenol (Isuprel) infusion may also be effective. Avoid
amiodarone, as this further prolongs the QT interval.
Management/Diagnostic Testing of Bradycardia. In pediatrics, bradycardia
associated with cardiovascular collapse is usually due to respiratory compromise
and responds to adequate ventilation. Asymptomatic bradycardia is not an
emergency.
A patient with bradycardia due to a primary dysrhythmia may be agitated and
combative due to poor cardiac output. Care must be taken not to sedate these
combative patients because doing so may precipitate cardiac arrest.
Causes of symptomatic bradycardia include pacemaker malfunction, complete
AV block due to Lyme disease, late onset postoperative complication, or
idiopathic causes. Sinus bradycardia may be due to sick sinus syndrome, drug
ingestion (i.e., beta-blocker, sedating medications, opioids, and seizure
medications), hypothyroidism, anorexia nervosa with or without cardiomyopathy,
myocarditis, or frequent blocked premature atrial contractions (PACs) ( Figs. 86.9
and 86.10 ). Infants discovered to have bradycardia due to 2:1 AV block should
be assumed to have LQTS until proven otherwise by a pediatric
electrophysiologist. EKG and long rhythm strip should be obtained. These
patients should be monitored on telemetry in case TdP develops.
