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What Can Be Done For Low Heart Rate?
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Thanks for the query,
1.My seven year old son s heart rate dropped to 44 while in the ER. Nothing was done to raise it. They would open the door to make sure someone was in there and close it. I know this is not right. What should be done for my son in the ER? He has had several seizures in the last month and has been admitted twice for them. They keep him overnight in the PICU to monitor him, but do nothing for the low heart rate. They don't even have a cardiologist come check him out
=== Such situations arise out of poor doctor patient communication. At times even momentary heart rate drops to 44 may be normal or a machine error.. or may be related to reduced fluids/temperature etc.
Is your child in ICU right now? why don't you attempt to stop a doctor and discuss your situation? After all its your child. What you are trying to say may be true, like say dropping heart rate and the perception that nothing was done for the child .This can really be serious and legally punishable if it is true and done without your consent.
Treatment for low heart rate may not always be "seen" ( as in CPR) especially when you were more than 5 feet or in another room. Low heart rate if the same was on clinical examination, may need specific drugs which might have been injected and you may not know unless it is put on paper.Its doctor's duty to mention either heart rate was not low on examination or if it is low, the drugs given for it. Often it may take few minutes to get the rates up with medicines if they were seriously low.
Cardiologist is not always required for management in ER, as most ER have trained physicians for managing emergencies including low heart rate. They do have a protocol.
You seem to have a feeling that the "doctors" just don't want to treat this child due to his seizure issues, this needs to be discussed with XXXXXXX doctor in the treating team.
Hope my answer is adequate, i will be available for follow up should you have any more concern.
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I understand your concern.
May be you are over protective, but do not loose faith in your doctor, and no interaction can survive with lost faith. Also, this attitude will interfere with treatment, decision making and psychology of doctors.
Again, I repeat
1. There should be documented proof of low heart rate, not just the monitor.
2. A cardiologist is not always available in ER as a cardiologist is not required for treating low heart rate in ER. ER people need to be trained in confirming and managing recent onset low heart rate as a life saving measure as it can be life threatening.
There are standard bradycardia (rate below 60) managing protocols which all ER doctors need to be aware of.
Neurologist and cardiologist do not have enough expertise in managing children as their training doesnt always involve enough pediatric exposure.
3. The CONFIRMED low heart rate situations may require any or all of the following measures including CPR, adrenaline, aminophylline, confirming heart block an arrhythmias.
4. Heart block and arrhythmia cases do have low heart rate and they may be stable with it. often one has nothing to act on emergency as it may not always create any further issues. Such cases may require a long term evaluation for cause of arrhythmia. Here cardiologist has important role to play.
5.Drugs like phenytoin or calcium IV given for seizure may cause low heart rate. Here a neurologist has some role to comment on.
Since you will be seeing your Cardiolgist and Neurologist on monday you will be able to discuss the issue with them.
I hope i could address your concerns, please reply if any further issues need to be cleared.
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Thanks for the query,
I appreciate your understanding and patience in the situation. There are some rare causes where doctors may need to just sit hands on waiting for time, even if the child is having some kind of focal twitching seizures or even if the heart rate is low as in some kind of arrhythmias, as at times further therapy may not be benefiting but harming the child at least for that time being.
But often, if it is noted for the first time, As i had told you before, there are protocols for managing bradycardia and seizures for each ER. Routine ER seizure control has a stepwise approach using 1-2 -3 -4 drugs one after another. Pediatric cardiologist is not required in ER unless ER pediatric doctors are not trained in managing the same.
Bradycardia, as i told you before, can be life threatening on routine cases and may need cardiopumonary resuscitation or drugs like adrenaline, atropine and dopamine or aminophylline.
Thanks for letting me know about the ECG heart rate, please get reconfirmed that the heart rate is same on repeat ECG and also it has no other arrhythmia that just needs to wait for further investigations and may be a pediatric cardiologist.
Hope my answer is adequate.
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