Q. Why does the pulse rate fall in a 4-year-old after administration of Epinephrine?
Hello doctor,
I am reviewing the patient care of a 4-year-old child diagnosed with the flu. He was having trouble breathing, so we called an ambulance. I was very apprehensive about him receiving any drugs from a doctor. His pulse was 149, 161, and 150 bpm. The medic then said his pulse was falling, which I did not see. He then requested an order to give Epinephrine, which does not make sense to me. His pulse rate then fell quickly. What is your opinion?
Hello,
Welcome to icliniq.com.
An ECG should have been done immediately to see if the child was having VT, SVT, or anything else that would require you to slow down the heart. Based on the ECG, the next step could have been planned. This is because you have only written to me about the heart rate. The other aspects, like breathing and circulation (blood pressure), also decide the modality of treatment. Does it make sense to give epinephrine to a child having tachycardia? However, if there was no pulse afterward, epinephrine should be given at that particular time.
Hello doctor, thank you so much for the reply.
He died shortly after he reached the hospital. I am blaming myself for calling EMS which took nearly an hour and gave him epinephrine. I got the EMS report with the numbers from the ECG. Can you help me, please? I feel I should have just taken him myself to the hospital. Here is everything I have.
Hello,
Welcome back to icliniq.com.
As per what I can make out from the ECG and the timings on it (attachment removed to protect the patient's identity), the activity of the heart was less just before giving Epinephrine. Hence I feel the timing was right. Also, the steps followed in the response sheet seem fine and fair enough, per my knowledge. You did the best you could, but eventually, you or I have no control over life. It is in God's hands ultimately. You should accept what has happened and move on with the thought process that you did the best you could for him.
Thank you.
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