Amiodare Case Study

Emergency Interventions
When treating a patient who has experienced or is currently in cardiac arrest, emergency care would follow Pediatric Advanced Life Support guidelines.34 If able during the resuscitation, a brief history, physical exam, and diagnostics should be done. As stated in PALS guidelines, amiodarone should be considered if a patient has arrhythmias unresponsive to defibrillation.11 Intractable arrhythmias are most commonly seen in patients with HCM. Though taking an extensive history is difficult in the emergency setting, questions about history of present illness, prior history of chest pain, shortness of breath and/or syncope during exertion, as well as family history of cardiac illnesses are essential in determining the etiology. Physical exam should

A transvenous single coil implantable cardioverter defibrillator (ICD) was placed on day five of hospitalization for secondary prevention due to the playground event being most likely a ventricular arrhythmia. He was discharged six days after presentation.
At the post-resuscitation review of the of the emergency department care, there were interventions that were helpful for his condition and others that could have been detrimental. For example, fluids were important to main the patient’s preload and therefore blood pressure. Seizure precautions such as the midazolam and the fosphenytoin could have deleterious effects of maintaining his blood pressure. Also, as mentioned above, our use of epinephrine could have worsened obstruction or potentiate an arrhythmia. Retrospectively, more effort should have been made to understand the history which would have elucidated the concern for a cardiac cause for the arrest. Also, a more detailed physical exam may have revealed a murmur, however this may have been difficult to detect in the resuscitation