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Question 15
•A 2-year-old male is rushed in by his parents after being found unconscious near open bottles of his grandfather' s medications. The airway is secure, and successful bag-valve ventilations are started. He is pulseless and unresponsive. Intravenous access is being obtained. The cardiac monitor shows a wide complex tachycardia at a rate of 260. What is the next step in management?
A.Shock the patient with 200 J.
B.Shock the patient with 0.5 J/kg.
C.Shock the patient with 2 J/kg.
D.Administer epinephrine 0.01 mg/kg IV.
Answer & Comments
•C
Comments:
–Although ventricular tachycardia and ventricular fibrillation are uncommon in children, they can occur with toxidromes or severe metabolic derangement.
–This child has pulseless ventricular tachycardia and should be immediately defibrillated.
–The appropriate initial energy setting for defibrillation in pediatric patients is 2 J/kg, then doubled for subsequent attempts.
–Cardioversion of unstable tachy-arrhythmias with a pulse begins at 0.5 J/kg and if unsuccessful is doubled for subsequent attempts.
–Epinephrine is indicated for pulseless arrest with ventricular tachycardia in children after unsuccessful defibrillation.
•A 2-year-old male is rushed in by his parents after being found unconscious near open bottles of his grandfather' s medications. The airway is secure, and successful bag-valve ventilations are started. He is pulseless and unresponsive. Intravenous access is being obtained. The cardiac monitor shows a wide complex tachycardia at a rate of 260. What is the next step in management?
A.Shock the patient with 200 J.
B.Shock the patient with 0.5 J/kg.
C.Shock the patient with 2 J/kg.
D.Administer epinephrine 0.01 mg/kg IV.
Answer & Comments
•C
Comments:
–Although ventricular tachycardia and ventricular fibrillation are uncommon in children, they can occur with toxidromes or severe metabolic derangement.
–This child has pulseless ventricular tachycardia and should be immediately defibrillated.
–The appropriate initial energy setting for defibrillation in pediatric patients is 2 J/kg, then doubled for subsequent attempts.
–Cardioversion of unstable tachy-arrhythmias with a pulse begins at 0.5 J/kg and if unsuccessful is doubled for subsequent attempts.
–Epinephrine is indicated for pulseless arrest with ventricular tachycardia in children after unsuccessful defibrillation.
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