Paediatric Cardiology in the ED

Here are some resources to gain further knowledge in this area

Reading a paediatric ECG

Starship

LITFL

McMaster University MacPeds Survival Guide

Perth Children’s Hospital

Syncope

When reading the ECG consider conduction disturbance (predisposing to complete heart block), acquired and inherited disorders associated with risk of dysrhythmia (WPW) or sudden cardiac death (Brugada, Arrhythmogenic RV Cardiomyopathy, QT abnormalities), and – especially in exertional syncope – left ventricular outflow obstruction (HOCM, aortic stenosis).

The acronym WOBBLER can help us remember to check these things in a left-to-right (P wave to T wave) approach:

Congenital Heart Disease in the ED

Consider duct dependent lesions if a patient presents in the first month (especially first week) of life with new onset cyanosis, ‘effortless tachypnoea’ or pallor/ shock.

Non specific symptoms and signs in infants include lethargy, poor feeding, sweating, and an enlarged liver.

For a good grasp of congenital heart disease emergencies this excellent podcast from the Emergency Medicine Cases team in Canada covers a lot of ground:

See also these videos from Open Pediatrics:

Fontan Circulation

Following ‘Fontan’ heart surgery the patient has a single functioning systemic ventricle which is used for providing cardiac output to the body. Blood flow to the lungs is not pumped by a ventricle, but relies on venous return directly from the vena cavae to pulmonary arteries. These patients are therefore very preload dependent and can be severely compromised by hypovolaemia.

Fontan patients are also at risk of thromboembolic disease and dysrhythmias. Adult patient survivors of congenital heart disease can have Fontan circulations.

This blog post is helpful from EM Ottawa:

Further information on patients with a Fontan circulation is provided in this article from University Hospital Birmingham

During the management of cardiac arrest in children and infants with known cardiac disease, specific modifications may be necessary to standard ACLS. These are discussed and summarise in this AHA article:

Cardiopulmonary Resuscitation in Infants and Children With Cardiac Disease

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Posted in Education, Teaching references

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