TYK196

A 12-month-old 10 kg male is undergoing repair of VSD. Separation from CPB is underway and the child’s ECG demonstrates a chaotic, uncoordinated rhythm, with a decrease in cerebral oximetry and systemic blood pressure. The next appropriate step in management would be:

a) Temporary pacing at 140 bpm

b) Atropine 200 mcg IV bolus

c) Immediate defibrillation with internal pads

d) Epinephrine 10 mcg IV bolus

e) Restarting CPB

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Answer

Answer c.

The ECG suggests ventricular fibrillation, and the definitive treatment for this rhythm is immediate defibrillation. Internal paddles, or externally applied pads may be used. Epinephrine at 10 mcg/kg and resuming CPB may be considered in the management algorithm, but will not solve the underlying dysrhythmia. Temporary pacing is inappropriate, as is atropine use in this setting.

Notes

This question originally printed in the Pediatric Anesthesiology Review Topics kindle book series, and appears courtesy of Naerthwyn Press, LLC.

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