A wide complex tachyarrhythmia, with monomorphic waveform and a regular rhythm could
be ventricular tachycardia (VT) or supraventricular tachycardia (SVT) with aberrant

The 2015 Pediatric Advanced Life Support (PALS) guidelines recommend an initial attempt
at treatment with adenosine, which may treat SVT or differentiate it from VT.

Lidocaine is an equivalent or preferred choice (alternative to amiodarone) for shock-resistant
VT or for VT/VF without a pulse. Lidocaine can be given via IO, IV or ET route.
HOCM Murmurs usually become louder with valsalva maneuvers, Aortic stenosis, the
murmurs usually become softer with Valsalva. Aortic stenosis and hypertrophic
cardiomyopathy are two known causes of sudden unexpected death in children

If the chest pain is nonreproducible and/or the chest pain or syncope is exercise related,
further evaluation and referral to a pediatric cardiologist is necessary to rule out potentially
life-threatening conditions such as aortic stenosis, hypertrophic cardiomyopathy, and
prolonged QT.
Murmurs on exertion
The initial fluid requirements in septic shock frequently exceed 60 mL/kg.

Inotropes, such as epinephrine, may be required, but only after adequate volume expansion
is achieved.

Steroids would be indicated for catecholamine-resistant septic shock or suspected adrenal

Packed red blood cells may be considered after the first hour if hemoglobin level is less than
10 g/dL.
Septic Shock
Long QT
The most common dysrhythmia associated with long QT syndrome is torsade de pointes.

Presents with a history of syncope, presyncope, palpitations and seizures.

Rx -  magnesium.