Tachycardia

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CPRinProgress

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I was working as a lifeguard today and it was brought to my attention, since I am an EMT, that a kid had a very fast heart rate. When I walked up to him he did not seem to be in any distress but when I took his pulse it was at 150. I could feel it in his chest. I told them to call 911 and I put him on oxygen. He didn't have any other complaints. Circulation x4 extremities. He said he hit his head 10 mins prior and his pupils were dialated but he said it did not hurt when he hit. When paramedics arriver they told him to bear down. This immediately slowed his rate. Any thoughts about what happened and why bearing down slowed his rate?
 
Look up vagal maneuvers.
 
What kind of history did the patient have? How about the remainder of his presentation and assessment? History of tachyarrythmias? Drug or stimulant use? I doubt hitting his head had anything to do with the problem in this case. The obvious answer would be SVT resolved by parasympathetic stimulation from bearing down. Vagal maneuvers such as these are typically recommended prior to pharmacological treatments of these rhythms as they are often effective in terminating them with an endogenous release of acetylcholine.
 
chaz90 said:
What kind of history did the patient have? How about the remainder of his presentation and assessment? History of tachyarrythmias? Drug or stimulant use? I doubt hitting his head had anything to do with the problem in this case. The obvious answer would be SVT resolved by parasympathetic stimulation from bearing down. Vagal maneuvers such as these are typically recommended prior to pharmacological treatments of these rhythms as they are often effective in terminating them with an endogenous release of acetylcholine.
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No history, no meds. Nothing was wrong with him except the tachycardia.
 
truetiger said:
How old was he? What was he doing when he hit his head?
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Hr was 11 years old and on the swim team so it wasn't that he was not use to swimming. He was swimming back stroke and ran into the wall but he said it did not hurt. The pupils being dialated and his heart racing with no history led me to believe it might be a head injury. The paramedics didn't think that was the case and thought the pupils were unrelated.
 
I think that may explain the tachycardia. Remember, his heart rate being "150" is not the same as an adult. If he's asymptomatic then I'd just watch him. No oxygen, no paramedics. You feeling his heart beating is not a symptom.
 
truetiger said:
I think that may explain the tachycardia. Remember, his heart rate being "150" is not the same as an adult. If he's asymptomatic then I'd just watch him. No oxygen, no paramedics. You feeling his heart beating is not a symptom.
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I see what you are saying but his pulse was bounding and it was not slowing. We called because the parents were not there and the dispatcher automatically dispatched medics.
 
I'm playing hockey a little bit later, come take my pulse during one of the breaks, it'll probably be bounding. Did you check a BGL? Kids his age tend to not prepare as they should for athletic events, I myself was guilty of this. Tachycardia and palpitations are a symptom. In fact, I remember this happening to me quite often near the end of practice. Give the kid some Gatorade.
 
CPRinProgress said:
I see what you are saying but his pulse was bounding and it was not slowing. We called because the parents were not there and the dispatcher automatically dispatched medics.
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Right, but what were the symptoms? I'm not saying you did the wrong thing here, but what made you feel the need to contact EMS in this situation? I think the previous poster is right in at least suggesting this could have been exercise related sinus tachycardia. From what you're saying, I'll reiterate that I really don't think this has anything to do with bumping his head.
 
I had very limited resources so I did not check bgl. It was high and it was not slowing down. I was lifeguarding so we only had a tank of 02. The medics said he was svt and they decided to acompany bls to the hospital so I don't think I was wrong in calling.
 
CPRinProgress said:
I had very limited resources so I did not check bgl. It was high and it was not slowing down. I was lifeguarding so we only had a tank of 02. The medics said he was svt and they decided to acompany bls to the hospital so I don't think I was wrong in calling.
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How long did you wait after assessing the patients HR until you called the medics? HR can take a little bit of time to drop down to normal rates.

With this call all we are able to do is do a Monday night quarterback of it. We don't have all the information, neither do you. It could have been SVT or it could have been Sinus Tach.
 
CPRinProgress said:
I had very limited resources so I did not check bgl. It was high and it was not slowing down. I was lifeguarding so we only had a tank of 02. The medics said he was svt and they decided to acompany bls to the hospital so I don't think I was wrong in calling.
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No problem. Glad the patient improved then.
 
CPRinProgress said:
I had very limited resources so I did not check bgl. It was high and it was not slowing down. I was lifeguarding so we only had a tank of 02. The medics said he was svt and they decided to acompany bls to the hospital so I don't think I was wrong in calling.
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I'm sorry, but I think it is pretty safe to say that the medics were wrong. A lot of medics have been taught the very very incorrect idea that any heart rate over 150 is automatically SVT. It isn't. That is a false statement.

I would be more worried if the kids HR wasn't 150 after swimming for a while.
 
I am not a medic and I didn't really see what they got on the monitor so I am not going to say if they were right or wrong. What I will say is that it was not just the rate that was wrong but from a distance I could see his sub clavicular vessels beating. He said he has never had any thing like this happen before even though he is actively swimming for the swim team. I feel like a 911 call was warranted and at that point it was not up to me whether ALS was dispatched or not. I was not going to sit there for an hour to see if the rate came down. After 10 minutes and it was still at 140 I felt like he needed to be checked out.
 
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I'm an adult woman and you can see my heart next to my sternum and pulse in my neck after a hard workout.

Barring any immediate life threats his parents should have been contacted, not 911.
 
Aidey said:
I'm an adult woman and you can see my heart next to my sternum and pulse in my neck after a hard workout.

Barring any immediate life threats his parents should have been contacted, not 911.
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So that's normal for you which is fine but when a kid that comes up to me saying his heart is fast and he has never had anything like this happen to him, I feel like something else is going on rather then just a fast heart rate from swimming.
 
That really is not that bizarre for a 11yo. Their max heart rate is upwards of 200. 150 just isn't that fast for a kid. Yeah, he can feel his heart beating, again not abnormal.
 
Redacted so I don't get *****ed at.

I know how it is as a lifeguard, I did it for a long time. Also did instructing and was eventually a supervisor for some time. I realize how limited the training is medically. You did what you felt was right.

I wasn't there and don't like to Monday-morning quarterback but from the information provided the medics overreacted. Call to mom, PO fluids, if primary symptoms develop call back or take him POV. Call his PCP. Clear AMA.
 
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CPR - I think that I would have to agree that this is probably a response to the exercise. Maybe he was working too hard, maybe he wasn't. Someone his age, it might happen, even if not normal for him. Coming from someone who work in NJ also, just because the medics "decided" to ride it in does not mean the patient actually required ALS intervention. We have many times that the medics ride in a patient and provide no treatment and sometimes not even advanced assessment.

It is also possible that their medical command might not have allowed them too. There are some ALS systems in NJ that require ALS to contact medical command for a triage, and medical command will not traige an SVT, just as a precaution.

We see it very often with diabetic patients that get fixed with some D50 but decide to be transported for assessment. Medical command in the area will not released a patient to BLS only because if we had to we could not reevaluate a BGL.
 
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