TYK102

A 14-year-old heart transplant patient is brought to the cardiac catheterization lab to have biopsies done to rule out possible acute rejection. On induction you note the following rhythm on the monitor:

The patient has pulsatility on the arterial line that correlates and a blood pressure of 65/31. What is the next step?

a) Defibrillation with 2 J/kg

b) Defibrillation with 4 J/kg

c) Epinephrine 1:10,000 dilution 10 mcg/kg

d) Synchronized cardioversion 0.5 J/kg

e) Begin chest compressions

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Answer

Answer D.

This patient has ventricular tachycardia (VT) with a pulse, but has hemodynamic instability. In this case, immediate synchronized cardioversion is indicated. The usual starting dose of 0.5 Joules/kg, but may be increased up to 1-2 Joules/kg for VT.

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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