PEDIATRIC ARRHYTHMIAS
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1 PEDIATRIC ARRHYTHMIAS Julie Martino, MD, FACEP Advocate Illinois Masonic Medical Center University of Illinois at Chicago
2 I have no relevant financial relationships with the manufacturer of any commercial product and/or providers of commercial services discussed in this CME activity I do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation. DISCLOSURES
3 Description: This lecture will discuss pediatric arrhythmia and the importance of evaluating ECG's in a timely and effective manner to avoid possible deadly consequences. Objectives: 1. Recognize hallmark pediatric arrhythmias. 2. Integrate best practice management options in pediatric patients. 3. Evaluate ECGs in a timely and effective process OBJECTIVES
4 JUST ANOTHER DAY IN YOUR COMMUNITY ED
5 Temp 37.0 tympanic HR 245 RR 40 BP 80/40 Pulse ox 99% 6kg (13 lbs) 3 month old baby boy brought by parents with vomiting and fussiness
6 EKG courtesy of Dr. Abhi Vallabhaneni
7 Sinus tachycardia or SVT? Sinus Tachycardia SVT HR (bpm) Infant Child <220 <180 >220 >180 Onset Gradual Abrupt Adapted from Manole M.D., and Saladino R.A. Emergency department management of the pediatric patient with supraventricular tachycardia. Pediatr Emerg Care 2007; 23: pp EKG Cardiac monitoring P-waves present; Upright P-waves in I, avf Variability in rate P-waves absent/abnormal: Inverted P-waves in II, III, avf No variability in rate CXR WNL +/- pulmonary edema
8 EKG courtesy of Dr. Abhi Vallabhaneni
9 VAGAL MANEUVERS Ice bag to face for 15 seconds Rectal temperature
10 Adenosine 0.1mg/kg IVP 0.2mg/kg IVP
11 EKG courtesy of Dr. Abhi Vallabhaneni
12 Cardioversion J/kg
13 Procainamide REFRACTORY SVT? Amiodarone
14
15 Triage RN drops an EKG on your desk
16 EKG courtesy of Dr. Randy Hebert
17 15y/o teenage girl with palpitations. Hx possible WPW Temp 37.2 oral HR 224 RR 20 BP 105/74 Pulse ox 99% 52kg (114lbs)
18 Procainamide 15mg/kg IV over min Monitor BP every 5 min and stop infusion if: Arrhythmia terminates Hypotension QRS widens Do NOT use: Adenosine Verapamil Beta-blockers Digoxin
19
20 EKG courtesy of Dr. Randy Hebert
21 HEY, DOC. I THINK YOU BETTER SEE THIS ONE RIGHT AWAY.
22 12y/o boy brought by grandmother c/o dizziness. Temp 36.8 oral RR 20 BP 102/74 Pulse ox 98% 38kg (83lbs) HR 280
23
24 Chiu S, Wu W, Lu C, et al. Primary ventricular tachycardia in paediatric population in a tertiary centre. Archives of Disease in Childhood Published Online First: 18 August doi: /archdischild
25 1. Medications 2. Cardioversion 3. Cry OPTIONS
26 Cardioversion 0.5 to 1 J/kg 2 J/kg
27 Chiu S, Wu W, Lu C, et al. Primary ventricular tachycardia in paediatric population in a tertiary centre. Archives of Disease in Childhood Published Online First: 18 August doi: /archdischild
28 Sathananthan, G; Harris, L; Nair, K. Ventricular Arrhythmias in Adult Congenital Heart Disease. Cardiac Electrophysiology Clinics. Published June 1, Volume 9, Issue 2. Pages
29 Kleinman ME, de Caen AR, Chameides L, et al. Pediatric basic and advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Pediatrics 2010; 126:e1261
30 Lidocaine Bolus dose 1mg/kg Infusion mcg/kg/min Amiodarone 5mg/kg over min Procainamide 15mg/kg over min
31 Chiu S, Wu W, Lu C, et al. Primary ventricular tachycardia in paediatric population in a tertiary centre. Archives of Disease in Childhood Published Online First: 18 August doi: /archdischild
32
33 REFERENCES Yates MC, Syamasundar RP (2013) Pediatric Cardiac Emergencies. Emergency Med 3: 164. doi: / Clausen H, Theophilos T, Jackno K, and Babl FE: Paediatric arrhythmias in the emergency department. Emerg Med J 2012; 29: pp Manole MD, Saladino RA Emergency department management of the pediatric patient with supraventricular tachycardia. Pediatr Emerg Care 2007; 23: pp Brugada J, et al. Pharmacological and non-pharmacological therapy for arrhythmias in the pediatric population: EHRA and AEPC-Arrhythmia Working Group joint consensus statement, EP Europace (9): Kleinman ME, de Caen AR, Chameides L, et al. Pediatric basic and advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Pediatrics 2010; 126:e1261 de Caen AR, Berg MD, Chameides L, et al. Part 12: Pediatric Advanced Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015; 132:S526.
34 REFERENCES, PART 2 Salerno JC, Seslar SP. Supraventricular tachycardia. Archives of Pediatrics and Adolescent Medicine Mar;163(3): Lewis et al. Acute Management of Refractory and Unstable Pediatric Supraventricular Tachycardia. Journal of Pediatrics, The, 2017; 181: e2 Chiu S, Wu W, Lu C, et al. Primary ventricular tachycardia in paediatric population in a tertiary centre. Archives of Disease in Childhood Published Online First: 18 August Sathananthan, G; Harris, L; Nair, K. Ventricular Arrhythmias in Adult Congenital Heart Disease. Cardiac Electrophysiology Clinics 2017; 9(2): de Caen AR, Berg MD, Chameides L, et al. Part 12: Pediatric Advanced Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015; 132:S526. Chang PM, Silka MJ, Moromisato DY, Bar-Cohen Y. Amiodarone versus procainamide for the acute treatment of recurrent supraventricular tachycardia in pediatric patients. Circ Arrhythm Electrophysiol. 2010;3(2):134. EKGs courtesy of: Abhi Vallabhaneni, MD and Randy Hebert, MD
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