Pediatric Tachycardia treatment

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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?

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?

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?

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?

<p>Proceed to synchronized cardioversion or defibrillation, and consider sedation. (A)</p> Signup and view all the answers

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?

<p>Assess the specific type of wide-complex tachycardia (Torsades de Pointes vs. Monomorphic VT) to guide appropriate intervention (such as defibrillation or synchronized cardioversion). (C)</p> Signup and view all the answers

Flashcards

Torsades de Pointes

A type of ventricular tachycardia characterized by varying QRS complex shapes and amplitudes. Treat with defibrillation.

Monomorphic VT

A type of ventricular tachycardia where the QRS complexes have a consistent shape. Treat with synchronized cardioversion.

Magnesium Sulfate (Peds)

Used in Torsades de Pointes. Administer 25 mg/kg IV/IO over 10 min.

Amiodarone (Peds)

An antiarrhythmic drug used for VT. Give 5 mg/kg in 50 ml NS over 20 min

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Etomidate (Peds)

Anesthetic with minimal cardiovascular effects for sedation during cardioversion. Dose: 0.15 mg/kg IV/IO.

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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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Description

This lesson covers Pediatric Tachycardia treatment, with unstable status changes. Includes absence of palpable radial pulse and algorithms for Torsades de Pointes (Polymorphic VTach). Covers Wide Complex or Monomorphic VT.