Pediatric emergency medicine trisk 1736 1736
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pacemaker is programmed to maximum output at an appropriate rate. Capture is
confirmed by palpating a pulse. The catheter should be secured with a sterile
dressing. There is a high risk of perforation, dislodgement, and infection in all
pediatric patients. Pediatric cardiology and/or electrophysiology should be
consulted early.
SUDDEN CARDIAC DEATH
CLINICAL PEARLS AND PITFALLS
Screen for SCD with a thorough personal and family history in all
syncope patients.
Knowledge of the cardiac causes of sudden death can guide
resuscitation, stabilization, and laboratory investigation.
Consider SCD in patients presenting with syncope without prodrome
and that occurs around the time of exercise.
Hypertrophic cardiomyopathy is the leading cause of death under the
age of 35 years, coronary artery disease is the leading cause of
sudden cardiac death over 35 years of age.
SCD is death occurring within 24 hours of onset of symptoms. The incidence
of SCD in infants, children, and adolescents is 1.3 to 8.5/100,000 patient-years.
Hypertrophic cardiomyopathy (HCM) is the most frequent cause of SCD in
people under 35 years of age. Other common causes of SCD in the young include
congenital coronary artery anomalies, disorders of the ventricular myocardium
(myocarditis, dilated cardiomyopathies, and ARVD), aortic rupture, and
arrhythmias (including channelopathies) make up the balance.
In adults with CHD, SCD increases with increasing age, increasing complexity
of CHD, and poor ventricular function. Arrhythmias are not tolerated well in
these patients.
