0071643192.pdf

■ Inadvertent inactivation
■ Any strong magnetic force can cause temporary or permanent (depend-
ing on device) failure.
■ Resistant VT or VFib
■ Device functioning, but rhythm resistant to internal defibrillation

SYMPTOMS/EXAM

■ May range from asymptomatic (found on device checkup) to cardiac arrest

TREATMENT

■ Definitive is reprogramming or replacement of device.
■ No risk from ICD for CPR providers
■ If external defibrillation is needed for VT/VFib
■ Use standard paddles, but place them≥10 cm away from generator.

A 17-month-old boy is brought in by his parents after 3 days of nonbloody

diarrhea. The child has had 6–8 soiled diapers a day, although in the 4 hours

prior to presentation the diaper has not required changing. On presentation

the child is noted to be clinging to his mother but not crying. His mucous mem-

branes are noted to be dry, and his eyes appear sunken. His HR is 120 and his SBP

is 80 mmHg. What is the initial indicator of moderate volume loss in the pediatric

patient? What is the most appropriate first treatment?

This child has lost a moderate volume of fluid. Because infants and young

children are fairly HR dependent for their cardiac output, tachycardia is the initial

indicator of moderate volume loss. The initial treatment should be a normal

saline bolus at 10–20 mL/kg.

VOLUME ASSESSMENT

Neonates

Newborns have very poor cardiac reserve and as a result progress rapidly to
circulatory collapse in the setting of even moderate volume loss. Volume loss
is associated with the following symptoms:

SYMPTOMS/EXAM

■ Tachycardia:Any increase of HR above the normal range of 120–160 bpm
■ Respiratory distress: Nasal flaring or grunting. This is a sign of increasing
stress and may be seen when volume loss is >5%.
■ Lethargy:Seen in moderate to severe volume loss (10–15%)
■ BP drop:Is the final sign of severe volume loss (> 15%) in a neonate and
is often precipitous.
■ When volume loss has occurred over a period of days
■ Changes in skin turgor are manifested by “doughiness” of the skin.
■ Decreased frequency of wet diapers
■ Sunken eyes and fontanelle
■ Dry mucous membranes and lack of tears

RESUSCITATION

Neonates may present with

respiratory distress as a sign

of volume loss.