• PDF / 174,834 Bytes
• 1 Pages / 595.245 x 841.846 pts (A4) Page_size
• 14 Downloads / 140 Views

DOWNLOAD

REPORT

---

1 S

Polymorphic ventricular tachycardia and ventricular fibrillation: case report A 6-year-old boy developed polymorphic ventricular tachycardia (PVT) and ventricular fibrillation (VF) following treatment with salbutamol and epinephrine [not all routes and dosages stated]. The boy, who had a preexisting phobia to common domestic animals, visited a friend’s home. The house had two of these animals which had been locked away in the basement. The animals were inadvertently released and approached the boy, causing him extreme emotional distress. He ran away screaming and crying and sought shelter in an upstairs bedroom. The parents of the friend captured the animals and secured them in the basement. They immediately checked on the boy at which time he was found to be unconscious. They called 9-1-1 and informed that the boy was not breathing. The call taker immediately generated an echo level (highest priority) call for a presumptive cardiac arrest. Prearrival CPR instructions were given. He had fright-induced cardiac arrest. He appeared to take a spontaneous breath after the first cycle of 30 chest compressions. However, there were no further spontaneous breaths. CPR was continued. Prior to the arrival of paramedics, three cycles of CPR were performed. Two paramedic units were simultaneously dispatched 41 sec after the initial call, with both units arriving on scene approximately 3 min and 23 sec after the 9-1-1 call was received. Initially, an asphyxial cause of cardiac arrest was anticipated. However, laryngoscopy revealed normal airway. An uncuffed endotracheal tube was inserted. Air entry was auscultated in all lung fields with no adventitious sounds noted at that time. Defibrillation pads were applied and coarse VF was noted on the screen. Therefore, a 50J shock was delivered within 6 min after the 9-1-1 call. At the end of the ensuing 2-min post-shock cycle of CPR, he was found to have a return of spontaneous circulation (ROSC) associated with a normal sinus rhythm (NSR) and strong peripheral pulses. A peripheral IV was obtained while ROSC care was performed. Weak spontaneous but ineffective respiratory efforts were observed requiring assisted ventilations. Following extrication and over the ensuing 20 min, his heart rhythm was NSR. Reassessment showed wheezing in all lung fields. Therefore, a metered dose inhaler adapter was placed on the airway tree and over 2 min, six doses of salbutamol 100µg were administered. Subsequent reassessment revealed that the wheezes had resolved. However, approximately one minute after completion of salbutamol administration, he developed uniform premature ventricular contractions (PVCs). The PVCs quickly increased in frequency over the ensuing minute leading to ventricular bigeminy. Periods of ventricular bigeminy alternated with NSR, which ultimately evolved to include polymorphic PVCs, short bursts of bidirectional ventricular tachycardia, and ultimately PVT, which occurred approximately 5 min after salbutamol administration. A pulse check could not detect a carotid pulse. A se