By Gershel, Jeffrey C.; Rauch, Daniel A.
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Additional info for Caring for the hospitalized child : a handbook of inpatient pediatrics
If the long QT is an incidental finding or discovered during the evaluation for syncope, immediately refer the patient to pediatric cardiology and arrange to screen all first-degree relatives. 16 Caring for the Hospitalized Child as close to the IV site as possible, followed by a rapid IV push of 5 to 10 mL of normal saline. Using a stopcock can facilitate the rapid infusion of the adenosine and flush. 2 mg/kg rapid IV push (12 mg maximum). 2 mg/kg rapid IV push (12 mg maximum). If the patient continues in SVT, consult a pediatric cardiologist to discuss the next step (further antiarrhythmics or synchronized cardioversion).
Chapter 2: Arrhythmias Ventricular Fibrillation (VF) Initiate basic life support, obtain IV/IO access, provide oxygen, ensure adequate ventilation, and place the patient on a monitor. Once VF is noted, proceed to immediate defibrillation. Give a single shock of 2 J/kg followed by 2 minutes of CPR; second shock of 4 J/kg followed by 2 minutes of CPR; subsequent shocks 4 J/kg or greater to a maximum of 10 J/kg or adult levels of energy. After the second defibrillation attempt, give epinephrine every 3 to 5 minutes as for asystole.
Terminal slurring of QRS 1. Wide slurred S in I, V5, V6 2. Terminal slurred R' in aVR, V4R, V1, V2 iv. ST depression and T wave inversion (not common in children) b. Left bundle branch block (LBBB): This is rare in children now that ventriculotomies are rarely performed, but can be seen after cardiac surgery (especially after procedures on the left side of the heart), and in hypertrophic cardiomyopathy and myocarditis. Criteria for LBBB include i. Left axis deviation ii. Prolonged QRS for age iii.