Pediatrics

Caring for the hospitalized child : a handbook of inpatient by Gershel, Jeffrey C.; Rauch, Daniel A.

By Gershel, Jeffrey C.; Rauch, Daniel A.

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Example text

Initial treatment depends on whether or not the patient is well perfused. If the patient is well perfused, initially attempt vagal maneuvers, such as covering the face with a bag full of slushy ice water, attempting a Valsalva maneuver, or performing unilateral carotid artery massage. 1 mg/kg rapid IV push (6 mg maximum) with the syringe Chapter 2: Arrhythmias If the patient presents with torsades de pointes, obtain serum electrolytes and urine drug screens and treat with magnesium sulfate 25 to 50 mg/kg IV (2 g maximum).

Start transcutaneous pacing, if readily available. Otherwise, treat with epinephrine as described for asystole. If there is increased vagal tone or the patient has an AV block, give atropine as described above for third-degree AV block. Situations where increased vagal tone is encountered include inferior myocardial disease, hypoglycemia, hypothyroidism, increased intracranial pressure, sick sinus syndrome, and potassium abnormalities. Numerous drugs, such as digoxin and β-blockers, can also cause increased vagal tone.

It is a severe, potentially fatal, multi-organ system allergic reaction. Therefore, it is imperative to recognize the signs and symptoms of anaphylaxis and treat it rapidly and appropriately. The most common causes are peanuts, tree nuts, and shellfish, although anaphylaxis in an inpatient may be triggered by latex, radiocontrast material, medications, or foods (Table 1-1). As many as 20% to 30% of patients will have a biphasic response, with most responses occurring within 1 to 8 hours after the initial reaction has abated.

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