Jonathan Mohnkern , Laura Williams , Christopher Fullagar
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Wide-complex tachycardia with an unusual response to electrical cardioversion in an adolescent with Chiari 1 malformation: A case report
Background
Pediatric patients with sustained tachyarrhythmias present unique challenges to prehospital clinicians due to differences in physiology, pathology, compensatory mechanisms, and treatment algorithms. Additionally, pediatric patients require careful thought into the psychosocial impacts that one's demeanor, treatment, and explanations will have on them.
Case report
This case illustrates an adolescent male with a history of Chiari 1 malformation who presented to EMS with sustained monomorphic ventricular tachycardia (VT). An unusual rhythm response was experienced during electrical cardioversion, where this intervention resulted in an immediate doubling of his heart rate.
Why should an emergency physician be aware of this?
We discuss approaches to pediatric dysrhythmias, differential diagnosis considerations, appropriate management of wide-complex tachycardia, and methods to reduce the psychological burden on patients and families in a first-encounter clinical situation.
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