Asymptomatic Pediatric SVT: Medicate or Wait?

[Aidey]

So Paramedics have no idea when treatments are indicated? We just blindly go around giving medicine and doing interventions without having a clue as to their indication? Really? No one is claiming to know everything or is asserting that Paramedics know as much as doctors. But we are more than capable of assessing a patient and knowing when something is indicated or not.

Some are, some are not. True story. 16 year old gets hit in the chest with a base ball, and is complaining of chest pain. Medic gave him nitro and aspirin for his "chest pain". Medic still is practicing. Here is another one, medic gives Bicarb for a trazodone OD without confirming it is a tricyclic (it is a tetracyclic), and ignoring the fact the pt had none of the indications to give it.

Edit - One more case, on topic. Ambulance crew arrives on scene to find the 20 something year old female patient RUNNING AWAY from the Fire Medic who was INSISTING that she needed adeosine, even after she explained to him that she had WPW and couldn't have it.

 

[WTEngel]

Fluid boluses and "asymptomatic" peds...

We all know kids can compensate extremely well for a certain amount of time...so a blood pressure in "normal" or "low normal" range does not necessarily ensure that hemodynamic compromise is not present. Without knowing what the SVR is (which you will never know in the field, and most likely not in a primary care pediatricians office) then we can't really tell what type of vascular compensation the kiddo is under.

So, with all that in mind, a 10-20 cc/kg bolus in just about any sick child is never a bad idea. I say this from 3 years of critical care peds transport working with extremely sick kids. I don't claim to be a pedi intensivist by any means, however, I would be surprised to find a pedi ER doc, intensivist, or cardiologist who did not agree...

I do agree with the treatment under the given circumstances. SVT without any quantitative or qualitative signs of hemodynamic compromise, start an IV (I have seen this convert a number of kids in and of itself) try some basic vagal maneuvers, and monitor VERY closely. Expect that they will crash, because like I said earlier, kids compensate very well for only so long, and when they crash, it is nearly instantly.

 

[Veneficus]

We all know kids can compensate extremely well for a certain amount of time...so a blood pressure in "normal" or "low normal" range does not necessarily ensure that hemodynamic compromise is not present. Without knowing what the SVR is (which you will never know in the field, and most likely not in a primary care pediatricians office) then we can't really tell what type of vascular compensation the kiddo is under.

So, with all that in mind, a 10-20 cc/kg bolus in just about any sick child is never a bad idea. I say this from 3 years of critical care peds transport working with extremely sick kids. I don't claim to be a pedi intensivist by any means, however, I would be surprised to find a pedi ER doc, intensivist, or cardiologist who did not agree...

I do agree with the treatment under the given circumstances. SVT without any quantitative or qualitative signs of hemodynamic compromise, start an IV (I have seen this convert a number of kids in and of itself) try some basic vagal maneuvers, and monitor VERY closely. Expect that they will crash, because like I said earlier, kids compensate very well for only so long, and when they crash, it is nearly instantly.

Strong post.

If I could I would just like to add that kids often "look fine" when they are indeed compensating, so always keep a high index of suspicion.

I have also seen many who transiently respond to treatment. So if they do "look better, get better," or whatever definately try to transport them as soon as possible and be very aware they can outright crash even after what looks like successful resus in a heartbeat.

 

[Akulahawk]

As others have indicated, had this kid become unstable, then I'd begin intervening. If I thought the kid might be trending towards unstable and my protocols guide me towards the "sit on hands until unstable" treatment option, I'd be on the radio or the phone to my OLMC to get an order to take care of business. In the case of Sacramento, since adenosine is NOT in the protocol for pediatric SVT, I'd have to get a base order to sedate/synch cardiovert. (It's actually NOT an approved med, period.) In the OP's case, in Sacramento, a Valsalva maneuver is indicated, along with transport.

I suspect that our protocols are set up that way because peds can handle high heart rates better than adults can and unless you're in a rural area, an ED is typically < 20 min away, if not closer. Since most of the County's residents are in an urban/suburban area, an ED will typically be about 10 min away.

At least our Protocols do tell us to make base contact for situations that aren't within the guidelines or that show a need to go beyond them.

 

[Akulahawk]

We all know kids can compensate extremely well for a certain amount of time...so a blood pressure in "normal" or "low normal" range does not necessarily ensure that hemodynamic compromise is not present. Without knowing what the SVR is (which you will never know in the field, and most likely not in a primary care pediatricians office) then we can't really tell what type of vascular compensation the kiddo is under.

So, with all that in mind, a 10-20 cc/kg bolus in just about any sick child is never a bad idea. I say this from 3 years of critical care peds transport working with extremely sick kids. I don't claim to be a pedi intensivist by any means, however, I would be surprised to find a pedi ER doc, intensivist, or cardiologist who did not agree...

I do agree with the treatment under the given circumstances. SVT without any quantitative or qualitative signs of hemodynamic compromise, start an IV (I have seen this convert a number of kids in and of itself) try some basic vagal maneuvers, and monitor VERY closely. Expect that they will crash, because like I said earlier, kids compensate very well for only so long, and when they crash, it is nearly instantly.

That's pretty much my train of thought with peds... and pretty much is what my County wants us to do with "stable" kids with SVT.

 

[JAXMEDIC1]

Prevent medicine is good medicine..NO MORE FREAKIN BALLOONS!!!LOL

Seriously though,in my opinion you did everything spot on to include "IV MAINT"..SVT is very common in PEDS and is rarely life threatening,but we must always act as the advocate of our patients.


"Some people watch beer commercials while others live them"

FIRE LIFE

 

[MrBrown]

Where are these guys when you need them?

 

[usalsfyre]

There is precious little I do anymore simply to satisfy "protocol". I treat based on what I think is indicated/will lead to the best outcome for the patient. If I don't feel as though an intervention will be paticularly helpful, I omit it. If a different med/intervention not in a paticular guideline will be helpful, I'm on the phone for an order. In extreme cases I'll go ahead and perform the intervention and doccument why I couldn't get a hold of med control. If this makes me a cowboy in your eyes than so be it, the important people (my medical director and clinical education staff) expect this from me.

Of course this also requires a strong understanding of pharmacology, pathophysiology, anatomy, ect.

 

[46Young]

I call BS. Part of being a competent clinician is having the discretion to not to perform specific interventions. It's done daily with regards to surgeries, meds for chronic conditions, ect.

I'm not advocating emptying the drug box just because you can. Actually, I've advised against it on other threads. When I say "indicated," I mean that the pt will benefit from the treatment, not something the medic thinks they should include just because the protocol says to. Lasix for every APE pt, or a D50 bolus for every hypoglycemic would be two such examples. NTG for costochondritis or pain when coughing from a pt w/ the flu would be another case. I thought that discretion was implied. I'm talking about withholding interventions that should help the pt. If I were to defer that treatment, for whatever reason, and the pt suffers harm or death, there goes my job, card, and house.

I've withheld interventions from time to time. For example, I had an elderly pt w/ symptomatic bradycardia, showing an idioventricular rhythm of 20. It was a while ago, but the BP was around 98/50 semi-fowler's (c/o dyspnea when supine), radial pulse wasn't thready, the pt was oriented and quick to respond, skin was a little pale, but not terribly so. So long as the pt didn't exert themselves, they were able to maintain. I could have paced, or given atropine (it obviously wouldn't have done anything), but I decided to only do a 12, O2 NC, IV, place the pads to be ready to pace, and I also had versed drawn up and ready, and my arrest meds/ETI equipment handy as well.

 

[46Young]

It's also negligent to delay transport because you think you know what's indicated.

:censored::censored::censored::censored:ing hell, if I had a quid for every sick patient that I've seen blued in with scene times of over an hour, I'd be buying more beer than I am now.

I know that a paramedic's level of education is far from that of a doctor, but we're expected to know what's indicated what's not. We would just carry the old air and chair and not much else if this wasn't the case. The presence of pediatric protocols and guidelines demand that we use them if indicated. Otherwise, every case would be load and go w/ supportive measures only. If we see something that can be corrected to some extent in the field, then we're going to do it. This typically happens enroute to the hospital in most cases. No one's delaying txp here, but we're not going to set up the monitor, drop a lock and stare at the pt all the way to the hospital when our interventions can be of benefit.

 

[SoCal]

.... on a side note....

so anytime we as EMS encounter a sick kid were not supposed to treat them because were not pediatricians, pediatric cardiologist, or the like?

^ Best post in the whole thread.

We have been given the tools to solve problems and the education to back them up. If it is broke (even stable SVT in my protocols) then fix it with what you have in the box. If you are unsure of your knowledge/protocols then consult with the ER Dr. at the receiving hospital.

The OP stated the pt. had received a 12 lead with confirmed SVT, so fix it, and transport him to the hospital where you can deliver the kid (fixed now) and the 12-lead and if they have any ?'s they can call the Dr. office he came from and even get the 12-lead from them as well.

This isn't a hard call and I am surprised how many medics on this site advocating acting so timidly. It backs up the knowledge that so many medics are scared of Peds. Kind of sad really....

 

[Fox800]

^ Best post in the whole thread.

We have been given the tools to solve problems and the education to back them up. If it is broke (even stable SVT in my protocols) then fix it with what you have in the box. If you are unsure of your knowledge/protocols then consult with the ER Dr. at the receiving hospital.

The OP stated the pt. had received a 12 lead with confirmed SVT, so fix it, and transport him to the hospital where you can deliver the kid (fixed now) and the 12-lead and if they have any ?'s they can call the Dr. office he came from and even get the 12-lead from them as well.

This isn't a hard call and I am surprised how many medics on this site advocating acting so timidly. It backs up the knowledge that so many medics are scared of Peds. Kind of sad really....

Interesting. This is the first vote for "medicate" after six pages of discussion.

 

[abckidsmom]

^ Best post in the whole thread.

We have been given the tools to solve problems and the education to back them up. If it is broke (even stable SVT in my protocols) then fix it with what you have in the box. If you are unsure of your knowledge/protocols then consult with the ER Dr. at the receiving hospital.

The OP stated the pt. had received a 12 lead with confirmed SVT, so fix it, and transport him to the hospital where you can deliver the kid (fixed now) and the 12-lead and if they have any ?'s they can call the Dr. office he came from and even get the 12-lead from them as well.

This isn't a hard call and I am surprised how many medics on this site advocating acting so timidly. It backs up the knowledge that so many medics are scared of Peds. Kind of sad really....

I disagree with this. While I am frustrated with the common phenomenon of medics being afraid of calls that involve kids, I believe that this is a circumstance where 10 minutes of caution with a stable patient is worth the trouble.

Knowing how randomly protocols are written and approved, I'm much less likely to apply a blanket protocol than my assessment of the situation and the risks and benefits specific to the patient I see before me.

What are the specific risks of adenosine administration for the 8 year old with stable tachycardia? What are the specific benefits of adenosine administration for the 8 year old with stable tachycardia?

How do those risks and benefits change when you consider a 10 minute transport time? 1 hour transport time?

How do those risks and benefits change when you consider the patient being slightly unstable (skin pale or mottled, slight dyspnea, slight hypotension)? How do they change when you consider the patient being profoundly unstable?

This is how the decision making process should go. Not, "I have a protocol for that so let me use it." More like, "There's a protocol for this, is it the best decision for this particular patient for me to go down that pathway?"

 

[Veneficus]

^ Best post in the whole thread.

I thought it was a good post too. While I was trying to diplomatically reach a consensus behind the scenes. My opinion is very much in line with ABC on this one.

We have been given the tools to solve problems and the education to back them up.

I think you are 50% right on this.

You have the tools to fix a problem, certainly not the education to back them up if you received a US paramedic education.

If it is broke (even stable SVT in my protocols) then fix it with what you have in the box..

Really?

Now I will admit that most kids who wind up with PSVT, will self resolve even if you don't do anything, and they may never have another episode again.

So if it fixes itself is it broke?

Let's consider for a minute:

Because of the normal development of the heart, all children have accessory conduction pathways. These pathways eventually fibrose as we become adults. Even in the cardiology community, there is no consensus as to when this actually happens, but the belief from the cardiologists who specialize at electrophysiology around here, the magic numbers are 13-14 for females and 15-16 for males. What if this kid was in SVT becase of an accessory conduction pathway?

No doubt any US paramedic can recite the ACLS guidlines, and certainly their local protocol. In the best interest of the patient this time, let the doctors (aka electrophysiology specializing cardiologists) have a look at what is going on so they can determine if a more invasive measure or no measure at all, would be a wise choice for a long term fix.

You have nothing more invasive, but yo do have "use nothing" in the tool box.

Sure cardio can restimulate it, but if the kid is stable, and relatively unsymptomatic, then it doesn't have to be reproduced, which means the child will only have to go through it once.

If you are unsure of your knowledge/protocols then consult with the ER Dr. at the receiving hospital.

I am very aware of the scope and guidlines I work under, For years I taught paramedics their knowledge and I still teach to more educated providers. I have years of experience working in a level I peds trauma center which also had on staff at all times pediatricians subspecializing in peds emergencies. The first surgery I ever assisted in was an emergent nephrectomy on an 8 year old. I can tell you the difference in essential amino acid metabolism between kids and adults, as well as the physical development characteristics as they have evolved through the evolution of homosapien. I am comfortable with patients of any age. I have also had a few years of education to boot.

Do you think the ER docs instantly initiate treatment on stable patients who are better served by a cardiologist or Peds cardiologist? (or any other specialty for that matter?)

Do you think they use more discretion on when that is?

Let's face it, not everyone in SVT is an emergency, the latest numbers I have heard is ~20% are emergent. With a confounder of a small percentage of people who die from SCD attributed as well. (but not as many peds who are attributed to long QT)

Every ED doc I have ever met who felt a patient was better cared for by another service referred the patient to them instead of opening up his box anymore than he absoltely had to in order to make sure they got to that specialist.

The reason we have peds EDs and what seems like a lot of peds transport teams is because they have better outcomes when served by specialists. (the cliche is kids are not small adults) They are actually more similar to the pupa stage of insects. See those university biology classes do make a difference in medicine.

We know EMS is not very efficent at saving lives. The best thing current US EMS can do for any patient is set them up for success by knowing what the next few links in the chain are and preparing patients for that.

Our friends in the rest of the modern world have better educated and equipped EMS providers to not always "fix" things, but to also recognize where and what type of care best serves patients. Thier education allows them to be both more knowledgable and therfore more comfortable than reciting protocols they had to memorize.

The OP stated the pt. had received a 12 lead with confirmed SVT,

Devil's advocate:

It was confirmed SVT and not a narrow complex ventricular tachycardia? Because they figured it out or the machine didn't tell them?

(did you learn in paramedic class sometimes you can have a narrow QRS of ventricular origin?)

Let me give you the benefit of the doubt. Let's say your protocols allow you to attempt a vagal maneuver, give 2 does of adensosine. (PALS recommendation for PEDS) and then cardiovert.

What if you gave this stable/unsymptomatic kid the adenosine and he didn't convert? Were you planning at that point to electively sedate and cardiovert him in the back of a rig?

If you felt cardioversion could wait a few minutes, why couldn't the adenosine?

What if the adenosine made him worse?

so fix it, and transport him to the hospital where you can deliver the kid (fixed now) and the 12-lead and if they have any ?'s they can call the Dr. office he came from and even get the 12-lead from them as well.,

The chief of cardiology where I did my cardio rotation said to me when speaking of treatment modalities, "If there is a mechanical defect, than the treatment is to mechanically fix it. If the treatment is otherwise medical in nature, then medications are the way to treat it. Do not try to treat mechanical defects with medicines, it simply won't work and delays the proper treatment."

So if this kid is indicated for ablative therapy. (surgical in nature) How do you plan to "fix" this kid's mechanical defect in the back of your rig and do anything but delay proper treatment?

This isn't a hard call

I think we agree on this. But for different reasons. Stable/unsymptomatic, do nothing and let the people who specialize in it do the voodoo that they do best.

and I am surprised how many medics on this site advocating acting so timidly.

Discretion is sometimes the better part of valor.

I do not see my support of not giving adenosine in this particular case as timid. I see it as knowing the best thing to do for the patient. Because I have some insight in to what could be wrong past an elementary discussion of it, as well as know what comes later down the line and think it is in the patient's best interest not to delay that care or provide a medication that will may not help or even be needed to begin with because most SVTs in kids self resolve.

I don't have to prove to anyone I am not afraid to follow a cookbook.

It backs up the knowledge that so many medics are scared of Peds. Kind of sad really....

I still have a valid paramedic cert in 2 states, so I am still a medic. I am not afraid of peds or any other patient.

I agree many people are. But the majority opinions I have seen here, even though they differ slightly, are based from sound clinical judgement, not fear.

If the scenario was different and the kid was grossly symptomatic, the benefit of immediate decisive action would in my mind outweigh any delay in treatment. But I would initiate that treatment fully prepared to cardiovert if something didn't work or went wrong.

If the kid was grossly unstable, I would cardiovert right away.

But there is no indication of either. So I again advocate to initiate supportive care and watch and wait for the 10 minutes it would take to transport. Not because I am afraid to act, but because I have a little knowledge/insight on what may be best.

 

[Akulahawk]

I disagree with this. While I am frustrated with the common phenomenon of medics being afraid of calls that involve kids, I believe that this is a circumstance where 10 minutes of caution with a stable patient is worth the trouble.

Knowing how randomly protocols are written and approved, I'm much less likely to apply a blanket protocol than my assessment of the situation and the risks and benefits specific to the patient I see before me.

What are the specific risks of adenosine administration for the 8 year old with stable tachycardia? What are the specific benefits of adenosine administration for the 8 year old with stable tachycardia?

How do those risks and benefits change when you consider a 10 minute transport time? 1 hour transport time?

How do those risks and benefits change when you consider the patient being slightly unstable (skin pale or mottled, slight dyspnea, slight hypotension)? How do they change when you consider the patient being profoundly unstable?

This is how the decision making process should go. Not, "I have a protocol for that so let me use it." More like, "There's a protocol for this, is it the best decision for this particular patient for me to go down that pathway?"

That's all fine, well, and good... if you have adenosine handy. My county removed (or never approved in the first place) adenosine. For SVT, our only option is to sedate (if possible) and synch. cardiovert. In fact, last I checked, Sacramento doesn't allow anything BUT electricity for breaking unstable tachycardias...

 

[Akulahawk]

I thought it was a good post too. While I was trying to diplomatically reach a consensus behind the scenes. My opinion is very much in line with ABC on this one.




I think you are 50% right on this.

You have the tools to fix a problem, certainly not the education to back them up if you received a TYPICAL US paramedic education.



Really?

Now I will admit that most kids who wind up with PSVT, will self resolve even if you don't do anything, and they may never have another episode again.

So if it fixes itself is it broke?

Let's consider for a minute:

Because of the normal development of the heart, all children have accessory conduction pathways. These pathways eventually fibrose as we become adults. Even in the cardiology community, there is no consensus as to when this actually happens, but the belief from the cardiologists who specialize at electrophysiology around here, the magic numbers are 13-14 for females and 15-16 for males. What if this kid was in SVT becase of an accessory conduction pathway? Funny that's shortly after the typical onset of puberty... and about the same time when humans start being able increase cardiac output via stroke volume and not just heart rate...
Prior to that, kind of makes use of adenosine rather redundant, doesn't it?
No doubt any US paramedic can recite the ACLS guidlines, and certainly their local protocol. In the best interest of the patient this time, let the doctors (aka electrophysiology specializing cardiologists) have a look at what is going on so they can determine if a more invasive measure or no measure at all, would be a wise choice for a long term fix.
Since I'm not a pediatric cardiologist, and especially not one specializing in electrophysiology, I get the patient to someone that is...
You have nothing more invasive, but yo do have "use nothing" in the tool box.

Sure cardio can restimulate it, but if the kid is stable, and relatively unsymptomatic, then it doesn't have to be reproduced, which means the child will only have to go through it once.



I am very aware of the scope and guidlines I work under, For years I taught paramedics their knowledge and I still teach to more educated providers. I have years of experience working in a level I peds trauma center which also had on staff at all times pediatricians subspecializing in peds emergencies. The first surgery I ever assisted in was an emergent nephrectomy on an 8 year old. I can tell you the difference in essential amino acid metabolism between kids and adults, as well as the physical development characteristics as they have evolved through the evolution of homosapien. I am comfortable with patients of any age. I have also had a few years of education to boot.

Do you think the ER docs instantly initiate treatment on stable patients who are better served by a cardiologist or Peds cardiologist? (or any other specialty for that matter?)

Do you think they use more discretion on when that is?

Let's face it, not everyone in SVT is an emergency, the latest numbers I have heard is ~20% are emergent. With a confounder of a small percentage of people who die from SCD attributed as well. (but not as many peds who are attributed to long QT)

Every ED doc I have ever met who felt a patient was better cared for by another service referred the patient to them instead of opening up his box anymore than he absoltely had to in order to make sure they got to that specialist.

The reason we have peds EDs and what seems like a lot of peds transport teams is because they have better outcomes when served by specialists. (the cliche is kids are not small adults) They are actually more similar to the pupa stage of insects. See those university biology classes do make a difference in medicine.

We know EMS is not very efficent at saving lives. The best thing current US EMS can do for any patient is set them up for success by knowing what the next few links in the chain are and preparing patients for that.

Our friends in the rest of the modern world have better educated and equipped EMS providers to not always "fix" things, but to also recognize where and what type of care best serves patients. Thier education allows them to be both more knowledgable and therfore more comfortable than reciting protocols they had to memorize.



Devil's advocate:

It was confirmed SVT and not a narrow complex ventricular tachycardia? Because they figured it out or the machine didn't tell them?
I generally prefer to do my own interpretation... because the machine can be wrong.
(did you learn in paramedic class sometimes you can have a narrow QRS of ventricular origin?)
I did... but then again, I didn't go to the typical school, nor did I arrive there having been "just" an EMT either...
Let me give you the benefit of the doubt. Let's say your protocols allow you to attempt a vagal maneuver, give 2 does of adensosine. (PALS recommendation for PEDS) and then cardiovert.

What if you gave this stable/unsymptomatic kid the adenosine and he didn't convert? Were you planning at that point to electively sedate and cardiovert him in the back of a rig?
Exactly. Why start down that path when kid's stable?
If you felt cardioversion could wait a few minutes, why couldn't the adenosine?

What if the adenosine made him worse?
Which is entirely possible with adenosine and those wonderful accessory pathways...


The chief of cardiology where I did my cardio rotation said to me when speaking of treatment modalities, "If there is a mechanical defect, than the treatment is to mechanically fix it. If the treatment is otherwise medical in nature, then medications are the way to treat it. Do not try to treat mechanical defects with medicines, it simply won't work and delays the proper treatment."
Wise man, your Chief of Cardiology was...
So if this kid is indicated for ablative therapy. (surgical in nature) How do you plan to "fix" this kid's mechanical defect in the back of your rig and do anything but delay proper treatment?



I think we agree on this. But for different reasons. Stable/unsymptomatic, do nothing and let the people who specialize in it do the voodoo that they do best.



Discretion is sometimes the better part of valor.

I do not see my support of not giving adenosine in this particular case as timid. I see it as knowing the best thing to do for the patient. Because I have some insight in to what could be wrong past an elementary discussion of it, as well as know what comes later down the line and think it is in the patient's best interest not to delay that care or provide a medication that will may not help or even be needed to begin with because most SVTs in kids self resolve.

I don't have to prove to anyone I am not afraid to follow a cookbook.



I still have a valid paramedic cert in 2 states, so I am still a medic. I am not afraid of peds or any other patient.

I agree many people are. But the majority opinions I have seen here, even though they differ slightly, are based from sound clinical judgement, not fear.

If the scenario was different and the kid was grossly symptomatic, the benefit of immediate decisive action would in my mind outweigh any delay in treatment. But I would initiate that treatment fully prepared to cardiovert if something didn't work or went wrong.
Knowing that use of adenosine can precipitate some rather lethal arrythmias, which can (and should) be quickly treated with electricity, I'd have that ready to go. Even with elective treatment. That would also mean being ready to sedate if the kid's still conscious...
If the kid was grossly unstable, I would cardiovert right away.
Right in line with our local protocols anyway. Spark 'em. He didn't appear to be, so why do it?
But there is no indication of either. So I again advocate to initiate supportive care and watch and wait for the 10 minutes it would take to transport. Not because I am afraid to act, but because I have a little knowledge/insight on what may be best.

Great discussion (and reminders about cardiology...) Thanks!!!

 

[abckidsmom]

That's all fine, well, and good... if you have adenosine handy. My county removed (or never approved in the first place) adenosine. For SVT, our only option is to sedate (if possible) and synch. cardiovert. In fact, last I checked, Sacramento doesn't allow anything BUT electricity for breaking unstable tachycardias...

Edit: Sorry about that. For some reason I thought you and SoCal were the same poster. My apologies for this snark.

 

[Veneficus]

"there is no consensus as to when this actually happens, but the belief from the cardiologists who specialize at electrophysiology around here, the magic numbers are 13-14 for females and 15-16 for males. What if this kid was in SVT becase of an accessory conduction pathway?"

"Funny that's shortly after the typical onset of puberty... and about the same time when humans start being able increase cardiac output via stroke volume and not just heart rate..."


I agree more with the stroke volume.

Typical onset of puberty in the western world is now at 9-11y/o for females and 11-13 for males. As humans work of survival levels decrease, the earlier the onset of reproductive capacity.

Modern convieniences like grocery stores, family support, and inactive lifestyles are wonderful things, but not without side effects.

 

[Akulahawk]

"there is no consensus as to when this actually happens, but the belief from the cardiologists who specialize at electrophysiology around here, the magic numbers are 13-14 for females and 15-16 for males. What if this kid was in SVT becase of an accessory conduction pathway?"

"Funny that's shortly after the typical onset of puberty... and about the same time when humans start being able increase cardiac output via stroke volume and not just heart rate..."


I agree more with the stroke volume.

Typical onset of puberty in the western world is now at 9-11y/o for females and 11-13 for males. As humans work of survival levels decrease, the earlier the onset of reproductive capacity.

Modern convieniences like grocery stores, family support, and inactive lifestyles are wonderful things, but not without side effects.

So very true!

 

[Akulahawk]

Edit: Sorry about that. For some reason I thought you and SoCal were the same poster. My apologies for this snark.

Not to worry... I evidently must have missed it.