Asymptomatic Pediatric SVT: Medicate or Wait?

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Fox800

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8 year old male, was riding in the back seat of a car, blowing up a balloon when he told parents he felt his heart racing. Parents played it off, ten minutes later kiddo still has the same complaint. Parents checked pulse, found it to be super-fast, took kiddo to pediatrician, who called 911.

Child presents without complaints. No palpitations, no chest pain/SOB/ligthheadedness/near-syncope/dizziness/weakness. Vital signs stable (aside from an initial pulse of 212-220). Skin pink/warm/dry, good cap. refill, clear lung sounds, everything looks fine. No history/meds/allergies. 12-lead EKG shows a regular, narrow-complex rhythm that holds between 210-215. No response to vagal maneuvers (had kid blow through a straw, ice pack to face, bear down).

The child's palpitations had subsided before you arrived on scene. You are 10 minutes by ground to the children's hospital (comprehensive care). You've successfully established an IV in the child's AC.

Adenosine, or no?

I'll tell you guys what happened in a little bit.
 
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No not at all, asymptomatic arrythmia in the short term does not require treatment from the Ambo's anyway. Take him to the hospital for further investigation where it will be decided by the people in white coats (who may or may not moonlight in orange jumpsuits) will decide if treatment is approprioate.
 
MrBrown said:
No not at all, asymptomatic arrythmia in the short term does not require treatment from the Ambo's anyway. Take him to the hospital for further investigation where it will be decided by the people in white coats (who may or may not moonlight in orange jumpsuits) will decide if treatment is approprioate.
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exactly
 
MrBrown said:
No not at all, asymptomatic arrythmia in the short term does not require treatment from the Ambo's anyway. Take him to the hospital for further investigation where it will be decided by the people in white coats (who may or may not moonlight in orange jumpsuits) will decide if treatment is approprioate.
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Agreed, I see no need for adenosine in an asymptomatic 8 yo
 
MrBrown said:
So where exactly is my taco man? Come on bro ....
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Is this considered 4th person? ;)

I agree. As long as the child stays asymptomatic, I personally would not perform any prehospital intervention.
 
Asymptomatic aside from the fast rate? In the pre-hospital setting, I'm very much inclined to simply observe and transport to a hospital that has a pediatric cardiologist or at least a cardiology unit that has some familiarity with peds. Kids can handle things like this far better than adults can. After all, from what I recall, their primary means of compensating for things is to stomp on the gas and kick up the heart rate.
 
I did the same thing you guys did. Watched the kid, gave him a conservative amount of fluids to see if anything might change (didn't). Transported to the children's hospital, they converted him wtih adenosine within about 10 minutes of our arrival. A-OK.
 
Asymptomatic..... you just answered your own question. Why the fluids? You didn't mention that he was hypotensive (the pt would be unstable then, no?). There was no mention of volume loss due to malnutrition, vomiting/diarrhea, etc.
 
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Had the kid been symptomatic/unstable... then sitting on my hands and simply observing would not be an option that I'd entertain for long.
 
46Young said:
Asymptomatic..... you just answered your own question. Why the fluids? You didn't mention that he was hypotensive (the pt would be unstable then, no?). There was no mention of volume loss due to malnutrition, vomiting/diarrhea, etc.
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This call was a while back. Thinking back, I don't think I actually gave fluids. D'oh.
 
Sounds like a great plan to me.


Here is some food for thought,

How would you have felt if you did give the kid adenosine, he converted, and the parents would have felt your efforts were enough and refused further treatment or transport?
 
If he is asymptomatic, monitor carefully and transport.
 
Frankly, even if he is symptomatic, you're ten minutes away from a paediatric emergency department. What's the question again?
 
46Young said:
Asymptomatic..... you just answered your own question. Why the fluids? You didn't mention that he was hypotensive (the pt would be unstable then, no?). There was no mention of volume loss due to malnutrition, vomiting/diarrhea, etc.
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Kids stay dry. Almost all kids drink only to thirst, especially with school days and asking permission to visit the water fountain, etc. Thus, when there's an insult to normal, a fluid bolus appropriate to the child's weight is a fine idea, IMO.
 
LondonMedic said:
Frankly, even if he is symptomatic, you're ten minutes away from a paediatric emergency department. What's the question again?
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I would have treated symptomatic in a heartbeat (snicker ;)). Why would we not? If the heart rate is such that it's not perfusing the brain properly, why wait?

This rate wasn't exceptionally high, though. I'm a chubby 30 something and I keep my heart rate in the 180s for 30 minutes when I work out. For an 8 yo heart, I am not too bothered by a rate of 210 in the short term with no symptoms.
 
abckidsmom said:
I would have treated symptomatic in a heartbeat (snicker ;)). Why would we not? If the heart rate is such that it's not perfusing the brain properly, why wait?
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Because there's a difference between symptomatic, cerebral hypoperfusion and irreversible cerebral hypoperfusion.

There's also a big difference between you and a paediatric emergency physician or a paediatric cardiologist.
 
LondonMedic said:
Because there's a difference between symptomatic, cerebral hypoperfusion and irreversible cerebral hypoperfusion.

There's also a big difference between you and a paediatric emergency physician or a paediatric cardiologist.
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I get the difference between symptomatic, cerebral hypoperfusiona nd irreversible cerebral hypoperfusion. In our over 1 hour transport times, these things matter. We never have the luxury of making the decision "now, or 10 minutes from now by the ER."

I respect your opinion on this, I'm just not clear. What's different about adenosine administration by a pediatric physician than a paramedic?
 
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