Question

A 1-year-old boy is brought to the ED for evaluation of poor feeding, irritability, and sweating. The child is lethargic but arousable. He has labored breathing, very rapid pulses, and a dusky color. His RR is 68 bpm, HR 300 bpm, and BP 70/45 mmHg. He has weak brachial pulses and absent radial pulses, a capillary refill of 6 secs, SpO2 85% on room air, and good bilateral breath sounds. You administer high-flow oxygen and place the child on a cardiac monitor and see the rhythm shown here. The child has no history of congenital heart disease. IV access has been established. What therapy is most appropriate for this child?

Answer 1

The 1-year-old boy with signs of cardiovascular shock and a critically high heart rate of 300 bpm requires immediate cardiac pacing and critical care interventions, including potential pharmacological therapy and IV fluids, under the guidance of a pediatric cardiologist.

Step-by-step explanation:

The clock is ticking for this 1-year-old boy who has presented in the emergency department (ED) with critical signs and symptoms that point toward a cardiovascular emergency. His significantly elevated heart rate (HR), profound tachycardia at 300 bpm, extremely low blood pressure (BP), and the dusky coloration of his skin all point towards circulatory shock. The most appropriate therapy for this child, given his lack of congenital heart disease history and the symptoms presented, is immediate cardiac pacing, alongside critical care interventions such as intravenous fluid administration and potential pharmacological therapy that may include vasopressors or antiarrhythmics, under the guidance of a pediatric cardiologist.

Because the situation is critical and taking into account that a very rapid pulse could indicate a potentially lethal arrhythmia, swift medical intervention is mandatory to stabilize the child's heart rhythm and to address the hypoperfusion and hypoxemia as evidenced by the capillary refill time of 6 seconds and SpO2 of 85% on room air. High-flow oxygen, which has been administered, is an integral part of the management, but it alone is not sufficient to correct the underlying causes of this child's distress.