Pediatrics

Myocardial Ischemia

Diagnosis

Recognition

  • ST depression >0.5 mm in any lead
  • ST elevation >1 mm (2mm in precordial leads)
  • Flattened or inverted T waves
  • Arrhythmia: VF, VT, ventricular ectopy, heart block

Diagnostic studies

  • 12-lead ECG:
    • II, III, aVF for inferior (RCA)
    • V5 for lateral ischemia (LCx)
    • V2, V3 anterior ischemia (LAD)
  • Compare to previous ECGs
  • Request Pediatric Cardiology consult and echocardiogram

Diagnosis

Recognition

  • ST depression >0.5 mm in any lead
  • ST elevation >1 mm (2mm in precordial leads)
  • Flattened or inverted T waves
  • Arrhythmia: VF, VT, ventricular ectopy, heart block

Diagnostic studies

  • 12-lead ECG:
    • II, III, aVF for inferior (RCA)
    • V5 for lateral ischemia (LCx)
    • V2, V3 anterior ischemia (LAD)
  • Compare to previous ECGs
  • Request Pediatric Cardiology consult and echocardiogram

  1. Improve O2 Supply:

    • Increase O2 to 100%
    • Correct anemia
    • Correct hypotension

  2. Decrease O2 Demand:

    • Reduce heart rate
    • Correct hypertension
    • Restore sinus rhythm

  3. Drug therapy (rarely needed in peds, consult a pediatric cardiac expert):

    • Nitroglycerin 0.5-5 MICROgrams/kg/min infusion
    • Consider heparin 10 Units/kg bolus, then 10 Units/kg/hour infusion

  4. Consider DDx

  5. Crisis Management (If Severe)

    Notify surgeon, call for help and code cart

  6. Call for Transesophageal Echocardiography

  7. Start chest compressions

  8. Give epinephrine 10 MICROgrams/kg IV/IO

  9. If cardiac arrest, go to CARDIAC ARREST

  10. Consider ECMO

Patient weight

Between 0.5 kg and 120 kg

Reset the checklist?

Checked steps, the timer and this crisis log are cleared. The patient’s weight is kept.

Finish the crisis?

The timer pauses, and you can review the case and the event log.