Cardiac Consultation in the Emergency Department

The challenge for the pediatric emergency medicine provider is to identify cardiac emergencies even when the chief complaint is not clearly cardiac. An additional challenge is to consider whether subspecialty consultation is required and, if so, to determine in what capacity and with what urgency. In this article, we review guiding principles surrounding subspecialty consultation in pediatrics and examine factors in all phases of a consultation from the perspective of both the pediatric emergency medicine provider and the pediatric cardiologist. In the Preliminary Phase, we discuss considerations surrounding whether a consult should be called and introduce the categories of "FYI" and "Curbside" calls. In the Action Phase, we review different circumstances appropriate for traditional (in-person) and telemedicine consultations. In the Aftercare Phase, we summarize the responsibilities of each party, emphasizing the need to ascertain appropriate access to effective follow-up care. We conclude by recommending that future efforts should be focused on collaboration between EDs and local pediatric cardiology groups to devise guidelines or clinical reference documents in regard to consultation expectations and parameters, with a suggested starting point included.