LISTSERV mailing list manager LISTSERV 16.5

Help for PED-EM-L Archives


PED-EM-L Archives

PED-EM-L Archives


PED-EM-L@LISTSERV.BROWN.EDU


View:

Message:

[

First

|

Previous

|

Next

|

Last

]

By Topic:

[

First

|

Previous

|

Next

|

Last

]

By Author:

[

First

|

Previous

|

Next

|

Last

]

Font:

Monospaced Font

LISTSERV Archives

LISTSERV Archives

PED-EM-L Home

PED-EM-L Home

PED-EM-L  April 2007

PED-EM-L April 2007

Subject:

Re: AMI in a 13 year old child

From:

Dan Drysdale <[log in to unmask]>

Reply-To:

Dan Drysdale <[log in to unmask]>

Date:

Fri, 6 Apr 2007 18:42:20 +0200

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (179 lines)

Excuse me 18% should be 80%
----- Original Message -----
From: "Dan Drysdale" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, April 06, 2007 4:37 PM
Subject: Re: AMI in a 13 year old child


> Dear,
>
> Were there any signs of Kawasaki syndrome? It's one of the possibilities
> that can explain myocardial infarction in a 13 year old child although 18
%
> occurs before age 5 and only 1% is lethal..
>
>
> ----- Original Message -----
> From: "Hisham Omran" <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Friday, April 06, 2007 3:04 PM
> Subject: Re: AMI in a 13 year old child
>
>
> > Gustavo
> >
> > Actually the previous EKG (3 years earlier) was perfectly normal.
> > The echo showed no pericardial effusion, and the reason we continued
with
> > atropine was the fact there was a good response the first dose.
> > Unfortunately, that response did not continue.
> > We did consider pacing but the patient's rhythm had gone into PEA and it
> was
> > felt that pacing was not going to be helpful so late into the condition.
> > As additional information, the Troponin came back positive (0.24).
> >
> > People had asked about the potential of autopsy. This is generally not
> done
> > in this country and the patients are usually buried within a short
period.
> > We did not ask the parents about doing an autopsy.
> >
> > Hisham Alomran
> > Emergency Department
> > King Faisal Specialist Hospital, Riyadh Saudi Arabia
> >
> >
> > -----Original Message-----
> > From: Gustavo E. Flores [mailto:[log in to unmask]]
> > Sent: Thursday, April 05, 2007 8:51 PM
> > To: 'hisham Omran'
> > Cc: Pediatric Emergency Medicine Discussion List
> > Subject: RE: AMI in a 13 year old child
> >
> > Greetings Dr. Alomran,
> >
> > It would be very interesting to see this kid's prior 12-lead EKG (if
> > available) and that during the final day. If available, could you post
it
> or
> > send it?
> >
> > When you say ST-depression in leads III and aVF with reciprocal changes
in
> > the laterals, do you mean lateral ST-elevations? If so, then a lateral
MI
> > with inferior reciprocal changes?
> >
> > What did the echo confirmed? Was there any pericardial effusion?
> >
> > After ruling out a pericarditis, If patient had pulse, and I was
> suspecting
> > an AMI, I would consider pacing rather an atropine and epi to increase
> heart
> > rate as it demands less O2 from an ischemic heart.
> >
> > Gustavo E. Flores Bauer, MSIII EMT-P :.
> > San Juan, Puerto Rico
> > Iberoamerican University School of Medicine
> > Santo Domingo, Dominican Republic
> > Web: www.EmergencyTeam.Net
> > E-Mail: [log in to unmask]
> >
> > "My karma ran over your dogma".
> > M:.M:.
> >
> >
> > -----Original Message-----
> > From: hisham Omran [mailto:[log in to unmask]]
> > Sent: Wednesday, April 04, 2007 3:38 AM
> > Subject: AMI in a 13 year old child
> >
> > I had an interesting child present to me a few days ago and I wonder if
> > anyone in the list has seen something similar.
> > This 13 year old boy came in with severe right sided chest pain (upper
> > sternal), and demanding oxygen. He had minimal cough and no SOB
> > He described non-radiating pain, worse with breathing and when sitting
up.
> > The HR 105, Afebrile, RR 20s, and sats 100% on RA.
> > He is known to have hyperesoniphilic syndrome and had been previously
> > admitted for a chest infection. He was discharged 10 days previously.
> > He was not on antibiotics but was on his usual doses of steroids and
> Imuran
> > (Azathioprin).
> > Immediately on applying oxygen he seemed to settle for a short while. A
> few
> >
> > minutes later he developed the pain again.
> > An EKG showed significant ST depressions in leads 3, aVF, and reciprocal
> > changes in the lateral leads.
> > We assumed some ischemic event was going on and prepared to start ASA,
> > Heparing, Morphine. While we did this, he became unconcious, and we
noted
> > a short run of Vfib. The rhythm resolved spontaneously and he awoke and
> > began to fight. Again we noted a run of wide complex QRS on the monitor,
> but
> >
> > with a pulse. Shortly therafter he went into a bradycardia with HR in
the
> > 40s.
> > CPR was maintained.
> > As we were preparing to intubate him, he would intermittently start
> moving,
> > and fighting the BMV. We noted his HR went upto 60 with one dose of
> > Atropine.
> > After intubation, he remained in a bradycardia with large ST elevations.
> > We attempted multiple doses of Atropine and then Epi but withtout the
same
> > response and the patient finally succumbed.
> > An echo confirmed no
> >
> > Our most likely diagnosis at that time was acute MI inferiolateral and
> > cardiogenic shock.
> >
> > I was wondering if anyone has
> > A. Seen hyperesiniophilic syndrome present with AMI at this age. The
> > primary
> > physician said he has seen such patients come with acute strokes, GI
> > ischemia. He states when they do thrombose, he describes it as an
> > esonophilic
> > thrombus and they usually progress and do poorly.
> > B. used thrombolytics in this age? Our pediatric cardiologists had no
> > experience
> > in this, and the adult cardiologists were very hesitant to attempt it.
> Their
> >
> > concern was the age, size of the child and the dose of tPA. In addition,
> as
> > for
> > PCI,their concerns were they couldn't offer appropriate back-up if there
> any
> > of
> > the expected complications.
> > C. Any experience with dosing of tPA in children?
> > D. Any other ideas about how management could have been different?
> >
> > Hisham Alomran
> > Emergency Department
> > King Faisal Specialist Hospital, Riyadh Saudi Arabia
> >
> > For more information, send mail to [log in to unmask] with the
> > message: info PED-EM-L
> > The URL for the PED-EM-L Web Page is:
> > http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
> >
> > For more information, send mail to [log in to unmask] with the
> message: info PED-EM-L
> > The URL for the PED-EM-L Web Page is:
> > http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html