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Questions and Answers
A 15 kg child presents with unstable wide-complex tachycardia, specifically Torsades de Pointes. Initial defibrillation is unsuccessful. What is the MOST appropriate next step in managing this child's arrhythmia?
A 15 kg child presents with unstable wide-complex tachycardia, specifically Torsades de Pointes. Initial defibrillation is unsuccessful. What is the MOST appropriate next step in managing this child's arrhythmia?
- Perform synchronized cardioversion starting at 0.5 to 1 J/kg.
- Increase defibrillation to 4 J/kg and consider sedation with etomidate 0.15 mg/kg IV/IO. (correct)
- Administer magnesium sulfate 25 mg/kg IV/IO over 10 minutes.
- Administer amiodarone 5 mg/kg IV/IO over 20 minutes.
A child with unstable monomorphic ventricular tachycardia (VT) does not respond to synchronized cardioversion at 1 J/kg. What is the MOST appropriate next step?
A child with unstable monomorphic ventricular tachycardia (VT) does not respond to synchronized cardioversion at 1 J/kg. What is the MOST appropriate next step?
- Increase synchronized cardioversion up to 2 J/kg or defibrillate at 2 J/kg increasing to 4 J/kg, and consider sedation. (correct)
- Administer magnesium sulfate 25 mg/kg IV/IO over 10 minutes.
- Administer amiodarone 5 mg/kg IV/IO over 20 minutes.
- Begin chest compressions and administer epinephrine.
A pediatric patient with unstable wide-complex tachycardia is being treated with amiodarone. After amiodarone administration, the rhythm remains unchanged. What is the MOST appropriate next step in management?
A pediatric patient with unstable wide-complex tachycardia is being treated with amiodarone. After amiodarone administration, the rhythm remains unchanged. What is the MOST appropriate next step in management?
- Immediately switch to an alternative antiarrhythmic medication.
- Repeat synchronized cardioversion or defibrillate and assess need for repeat sedation; consider repeating amiodarone. (correct)
- Administer another dose of amiodarone at a higher concentration.
- Increase the rate of amiodarone infusion to achieve a faster response.
During the management of a child with unstable tachycardia and a wide QRS complex, after administering magnesium sulfate, there is no change in the child's rhythm. What should be the next intervention?
During the management of a child with unstable tachycardia and a wide QRS complex, after administering magnesium sulfate, there is no change in the child's rhythm. What should be the next intervention?
A child with a heart condition develops unstable wide-complex tachycardia. Vascular access has been obtained, and a cardiac monitor is in place. What is the initial, MOST crucial step in managing this arrhythmia based on the provided information?
A child with a heart condition develops unstable wide-complex tachycardia. Vascular access has been obtained, and a cardiac monitor is in place. What is the initial, MOST crucial step in managing this arrhythmia based on the provided information?
Flashcards
Torsades de Pointes
Torsades de Pointes
A type of ventricular tachycardia characterized by varying QRS complex shapes and amplitudes. Treat with defibrillation.
Monomorphic VT
Monomorphic VT
A type of ventricular tachycardia where the QRS complexes have a consistent shape. Treat with synchronized cardioversion.
Magnesium Sulfate (Peds)
Magnesium Sulfate (Peds)
Used in Torsades de Pointes. Administer 25 mg/kg IV/IO over 10 min.
Amiodarone (Peds)
Amiodarone (Peds)
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Etomidate (Peds)
Etomidate (Peds)
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Study Notes
- Pediatric Tachycardia with Unstable Status Changes including absence of Palpable Radial Pulse, requires the following algorithm:
- Initiate general pediatric assessment.
- Cardiac monitor should be attached.
- Establish vascular access.
Torsades de Pointes (Polymorphic VTach)
- Defibrillate at 2 J/kg, increasing to 4 J/kg.
- Consider sedation with Etomidate at 0.15 mg/kg IV/IO.
- If rhythm change, follow the "yes" path, otherwise:
- Administer Magnesium Sulfate at 25 mg/kg IV/IO in 50 ml NS over 10 minutes.
- If rhythm changes, follow the "yes" path, otherwise continue with general pediatric assessment.
Wide Complex (≥0.12 Sec) or Monomorphic VT
- Perform synchronized cardioversion starting at 0.5 to 1 J/kg.
- May increase to 2 J/kg if unsuccessful or defibrillate at 2 J/kg, increasing to 4 J/kg.
- Consider sedation with Etomidate at 0.15 mg/kg IV/IO.
- If rhythm changes, follow the "yes" path, otherwise:
- Administer Amiodarone at 5 mg/kg in 50 ml NS over 20 minutes.
- If rhythm changes, follow the "yes" path, otherwise:
- Repeat Synchronized Cardioversion or Defibrillation.
- If VT is not resolved, assess the need for repeat sedation.
- Repeat Amiodarone.
- If rhythm changes, follow the "yes" path, otherwise continue with general pediatric assessment.
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