Quick Reference Card¶

One-page summary of the most critical information for pediatric cardiology rotation

When to Call Cardiology¶

Finding	Action
Failed CCHD screen	Consult immediately + echo
Cyanosis + minimal distress	Consult + consider PGE1
SVT not breaking with vagal	Consult + adenosine
Wide complex tachycardia	Consult immediately (assume VT)
New complete heart block	Consult + temporary pacing ready
Syncope with exertion/palpitations	Consult + ECG + hold from activity
New murmur + HF symptoms	Consult + echo
Suspected Kawasaki	Consult within hours

Finding	Action
Asymptomatic murmur	Outpatient echo
Chest pain, normal exam	Reassurance usually OK
Benign syncope pattern	Consider referral if recurrent
Family history of SCD	ECG + consider referral
Palpitations, normal ECG	Monitor if persists

Drug	Dose	Max	Indication
Adenosine	0.1 mg/kg IV push	6 mg 1st, 12 mg 2nd	SVT
Epinephrine (arrest)	0.01 mg/kg IV/IO	1 mg	Cardiac arrest q3-5 min
Amiodarone (arrest)	5 mg/kg IV	300 mg	VFib/pVT
Atropine	0.02 mg/kg IV	0.5 mg (child), 1 mg (adolescent)	Bradycardia
Magnesium (Torsades)	25-50 mg/kg IV	2 g	Torsades de pointes
PGE1	0.05-0.1 mcg/kg/min	—	Ductal-dependent lesion
Cardioversion	0.5-1 J/kg sync	2 J/kg	SVT/VT with pulse
Defibrillation	2 J/kg → 4 J/kg	—	VFib/pulseless VT

Age	Upper Limit Normal	Prolonged
All ages	<450 ms	>460 ms
—	—	>480 ms = Definite LQTS

Kawasaki: Treat by day 10 of illness to prevent CAA; IVIG + high-dose ASA
CCHD Screening: ≥95% in BOTH extremities AND ≤3% difference to pass (2025 update)
SVT vs Sinus Tach: SVT is abrupt onset, fixed rate, no P waves; sinus tach is gradual, variable, with upright P waves
Wide complex tachycardia: Assume VT until proven otherwise
Torsades treatment: IV Magnesium first (even with normal Mg level)
Epinephrine timing (2025 PALS): ASAP for non-shockable; after 2nd shock for shockable
Innocent murmur features: Grade 1-2, systolic, musical/vibratory, no click, normal S2, changes with position
Complete heart block + wide QRS escape: Needs pacemaker (unstable escape rhythm)
Post-op CHB >7 days: Unlikely to resolve → permanent pacemaker indicated
Fontan patients: All are functionally in chronic HF; aggressive volume resuscitation needed

HIGH Risk (Prophylaxis Required)
Prosthetic valve or material
Previous infective endocarditis
Unrepaired cyanotic CHD
Repaired CHD with residual defect at/near prosthetic
Cardiac transplant with valvulopathy

Needs Prophylaxis	No Prophylaxis Needed
Dental: gingival manipulation, perforation of oral mucosa	Routine anesthesia through non-infected tissue
Respiratory: incision/biopsy of mucosa	Bronchoscopy without incision
Infected skin/tissue	GI/GU procedures (unless infected)

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