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TREATMENT

■ Unstable →immediate cardioversion
■ Synchronized
■ Begin with 50–100J
■ Magnesium infusion
■ Increase the ventricular rate (to shorten repolarization).
■ Isoproterenol infusion or
■ Overdrive pacing (external or transvenous)
■ To ventricular rate of 100–120 bpm
■ Amiodarone may be tried, if patient is stable.
■ Avoid: Any drugs that can prolong repolarization (eg, procainamide).

VENTRICULARFIBRILLATION(VFIB)

Ventricular fibrillation is totally disorganized ventricular depolarization. Causes
are similar to VT (above).

ECG FINDINGS(SEEFIGURE1.18)

■ Zig-zag pattern without P waves or QRS complexes

TREATMENT

■ See “Management of Cardiac Arrest.”

Management of Cardiac Arrest

The four causes of pulseless cardiac arrest include VFib, pulseless VT, pulse-
less electrical activity, and asystole.

In comparison to the adult population, a primary cardiac cause (sudden
cardiac death) of cardiac arrest is uncommon in the pediatric population.
Pediatric arrest is most commonly secondary to progressive hypoxia or
shock.

RESUSCITATION

FIGURE 1.17. Torsades de pointes (atypical ventricular tachycardia).

FIGURE 1.18. Ventricular fibrillation.

(Reproduced, with permission, from Tintinalli JE, Kelen GD, Stapczynski JS. Emergency
Medicine: A Comprehensive Study Guide, 6th ed. New York: McGraw-Hill, 2004:191.)

Pediatric cardiac arrest is most

commonly due to progressive

hypoxia or shock.