Inpatient Clinical Pathway for Child with Prolonged QTc
and Prevention of Torsades de Pointes
Inpatient with Prolonged QTc on 12-Lead Electrocardiogram
This pathway provides guidance for consultation, management,
and telemetry monitoring for inpatients with QTc prolongation
This pathway provides guidance for consultation, management,
and telemetry monitoring for inpatients with QTc prolongation
FLOC Assessment
- Review:
- Vital signs, physical exam
- Risk Factors/Conditions Associated with Prolonged QT
- Current medications, recent laboratory values
- Completed 12 lead ECG, including other abnormal findings of importance
- Initiate clinical actions based on automated ECG reading
(machine interpretation) pending confirmation by Cardiac EP service
QTc ≥ 470-499 ms
Contact Cardiology Consult service for guidance
Contact Cardiology Consult service for guidance
QTc ≥ 500 ms
FLOC consult PHL Cards EP service for expeditious confirmation of ECG findings, specifically QTc interval
FLOC consult PHL Cards EP service for expeditious confirmation of ECG findings, specifically QTc interval
Hemodynamically Stable
without ventricular
arrhythmia
without ventricular
arrhythmia
Hemodynamically Stable
with non-sustained ventricular arrhythmia
with non-sustained ventricular arrhythmia
- Non-sustained ventricular tachycardia:
- ≥ 3 consecutive ventricular beats lasting < 30 sec
- Frequent ventricular ectopy:
- > 2 PVCs per 10 sec
- > 30 per hour
Hemodynamically Unstable
with sustained ventricular tachycardia/torsades de pointes
with sustained ventricular tachycardia/torsades de pointes
- Call Critical Assessment Team (CAT)
- Consult PHL Cards EP service immediately
- Call Code Response
- Consider magnesium sulfate IV
- 50 mg/kg/dose
Max dose 2 g/dose
- 50 mg/kg/dose
- Consult PHL Cards EP service immediately
- Transfer to ICU
Initiate Telemetry/Supplemental Arrhythmia Monitoring
- Telemetry
- Real-time alarm response
- Cardiac Center (CICU, CCU, CPRU, ITCU)
- Supplemental Arrhythmia Monitoring
- Intermittent review of non-audible alarms
- Non-Cardiac Center (N/IICU, PICU, PCU)
Risk Factors/Conditions for Prolonged QTc |
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Monitoring |
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Posted: March 2023
Authors: C. Srinivasan, MD; N. Bernard, RN; H. Wolfe, MD; H. Stinson, MD; J. Freedman, MD; V. Vetter, MD
Authors: C. Srinivasan, MD; N. Bernard, RN; H. Wolfe, MD; H. Stinson, MD; J. Freedman, MD; V. Vetter, MD
Evidence
- QT Assessment in Early Drug Development: The Long and the Short of It
- Predictive Analytics for Identification of Patients at Risk for QT Interval Prolongation: A Systematic Review
- Prevalence and Outcome of High-Risk QT Prolongation Recorded in the Emergency Department from an Institution-Wide QT Alert System
- Development of a Risk Score for QTc-prolongation: the RISQ-PATH Study
- Phenotype of Children with QT Prolongation Identified Using an Institution-Wide QT Alert System
- Effectiveness of a Clinical Decision Support System for Reducing the Risk of QT Interval Prolongation in Hospitalized Patients
- Development and Validation of a Risk Score to Predict QT Interval Prolongation in Hospitalized Patients
- Risk Factors for Recurrent Syncope and Subsequent Fatal or Near-Fatal Events in Children and Adolescents With Long QT Syndrome
- Prevention of Torsade de Pointes in Hospital Settings
- The Prevalence and Factors Associated With QTc Prolongation Among Emergency Department Patients
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