Pediatric emergency medicine trisk 0230 0230

syndrome, structural heart disease, myocarditis, cardiomyopathy, and poisonings In children presenting with stable VT, close monitoring and immediate consultation with a pediatric cardiologist to determine etiology and definitive treatment is the best management For children with VT with signs of poor perfusion (altered mental status, delayed capillary refill, hypotension), begin with synchronized cardioversion It is important to recognize that SVT, while typically narrow complex, can also present with wide-complex tachycardia in some instances; therefore, in the stable patient with either wide- or narrow-complex tachycardia, adenosine can be given For hemodynamically stable patients with VT, chemical conversion using amiodarone or procainamide could be considered in conjunction with consultation with an expert EXTRACORPOREAL CARDIOPULMONARY RESUSCITATION There is now some information regarding the use of extracorporeal CPR (E-CPR) through the use of extracorporeal membrane oxygenation (ECMO) or cardiopulmonary bypass following CPR to treat refractory cardiac arrest in children presenting to an ED setting Currently, it is an option available primarily in large, tertiary care children’s hospitals The majority of the literature to date comes from the treatment of inpatients with primary cardiac disease, and available studies on use for pediatric IHCA favor the use of E-CPR The 2010 Guidelines state “There is insufficient evidence to recommend the routine use of ECPR for patients in cardiac arrest However, in settings where ECPR is readily available, it may be considered when the time without blood flow is brief and the condition leading to the cardiac arrest is reversible or amenable to heart transplantation or revascularization.” The 2015 Guidelines were changed to state that “E-CRP may be considered for children with underlying cardiac conditions who have IHCA” given no clear difference in survival found for ECPR versus standard CPR for IHCA in noncardiac patients While the patient and disease factors which make E-CPR least likely to be effective are still not fully known, the use of E-CPR may be considered for children who have had a short downtime and have received high-quality CPR, especially among patients where a cardiac etiology is suspected, when the resources and personnel are available NEWLY BORN INFANT RESUSCITATION Guidelines for CPR in the newly born infants transitioning from intrauterine to extrauterine life and for neonates who have completed the transition and require resuscitation during the first few weeks after birth differ from guidelines for CPR of older infants and children who present to the ED ( Fig 9.16 ) For non-newly born young infants presenting in cardiac arrest, either newly born (NRP)