This case is written by Drs. Laura Simone and Olivia Ostrow. They are both Pediatric Emergency Physicians at Toronto’s Sick Kids Hospital.
Why it Matters
SVT is the most common pediatric dysrhythmia that we see in the ED after sinus tachycardia. But sometimes, in very young children and infants, it can be hard to distinguish the two! This case highlights some important features of the management of SVT, including:
- The need for an ECG when they heart rate is very high
- The role of vagal maneuvers as a first attempt at cardioversion
- The dosing of adenosine and electricity for cardioversion of SVT
Clinical Vignette
A 12-month old male is brought into your ED today by his parents because he has been fussy, crying all night and not feeding well today. He had emesis x 1 (non-bilious, non-bloody). At triage, the RN had difficulty recording the heart rate but by auscultation it seemed “quite rapid” and he “feels a bit warm”.
Case Summary
The team has been called to the ED after a 12-month old is brought in with a rapid heart rate. The team will realize the patient is in a stable SVT rhythm, with no response to either vagal maneuvers or adenosine. The patient will then progress to having an unstable SVT. If the SVT is defibrillated (i.e. – shocked without synchronization), the patient will progress to VT arrest. If the SVT is cardioverted, the patient will clinically improve.
Download the case here: Pediatric SVT
Initial ECG for the case found here:
Source = https://pemcincinnati.com/blog/pediatric-svt/
Post-Cardioversion ECG for the case found here:
(ECG source: http://lifeinthefastlane.com/ecg-library/sinus-tachycardia/)
VT ECG for the case found here:
(ECG source: https://lifeinthefastlane.com/ecg-library/ventricular-tachycardia/)
EM Sim Cases 