Departments of aPediatrics, Emory University School of Medicine, Atlanta, GA 30329, USA.
Pediatrics. 2013 May;131(5):e1654-8. doi: 10.1542/peds.2012-1607. Epub 2013 Apr 29.
Any injured patient who is cool and tachycardic is considered to be in shock until proven otherwise.(1) We describe the diagnostic challenge when evaluating persistent tachycardia in the setting of multiple system trauma with hemorrhagic shock. This is a unique case of a 17-year-old patient with the secondary condition of cardiogenic shock due to supraventricular tachycardia (SVT) complicating ongoing hemorrhagic shock from a facial laceration. She had sustained tachycardia despite aggressive resuscitation and required medical cardioversion 30 minutes after arrival to the emergency department. After successful conversion, she maintained normal sinus rhythm for the rest of her hospitalization. During her follow-up cardiac catheterization, she was found to have a left-sided accessory pathway, consistent with atrioventricular reciprocating tachycardia. This is a unique and rare case of SVT in the traumatic patient. We review causes of tachycardia in the setting of pediatric multisystem trauma, as well as discuss acute SVT evaluation and management in the pediatric emergency department.
任何表现为体温低和心动过速的创伤患者，在明确之前都应被视为休克患者。(1) 我们描述了在合并失血性休克的多发创伤患者中评估持续性心动过速时所面临的诊断挑战。这是一个独特的病例，一名 17 岁患者合并心源性休克，继发于室上性心动过速（SVT），同时伴有因面部撕裂伤导致的持续失血性休克。尽管进行了积极的复苏，但她仍持续心动过速，在到达急诊科 30 分钟后需要进行医疗电复律。电复律成功后，她在整个住院期间保持窦性心律正常。在她的后续心脏导管检查中，发现她有左侧旁路，符合房室折返性心动过速。这是创伤患者中 SVT 的一个独特而罕见的病例。我们回顾了儿科多发创伤患者心动过速的原因，并讨论了儿科急诊科急性 SVT 的评估和管理。
