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Cardiac Emergencies

Cardiac Emergencies. PALS April 25, 2017. Overview. Differential of the sick infant Left sided vs right sided lesions How to detect congenital cardiac lesions How to manage congenital cardiac lesions. This baby looks sick. Sepsis Sepsis Sepsis Congenital Heart Disease

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Cardiac Emergencies

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  1. Cardiac Emergencies PALS April 25, 2017

  2. Overview • Differential of the sick infant • Left sided vs right sided lesions • How to detect congenital cardiac lesions • How to manage congenital cardiac lesions

  3. This baby looks sick • Sepsis • Sepsis • Sepsis • Congenital Heart Disease • Congenital Adrenal Hyperplasia • Inborn Errors of Metabolism • Abdominal Catastrophies • Neurologic Conditions • NAI

  4. Congenital Heart Disease • Classic time of presentation is in the first two weeks of life • Right-sided lesions present with cyanosis • Blue baby • Left-sided lesions present with poor perfusion and shock • Grey baby

  5. What CHD could it be?

  6. Congenital Heart Disease • Historical features are often non-specific • Increased fussiness or irritability • Particularly with feeds • Lethargy • Mottling • Abnormal or rapid breathing, grunting • Poor weight gain and feeding • Diaphoresis with feeding • Squatting

  7. When do these lesions present?

  8. Physical Exam • Vital signs – preductal and postductalsats and BPs • Avoid the left arm! • Other findings • Normal heart sounds? • Murmurs? • HSM? • Pulses? Brachial-femoral delay? • Perfusion

  9. Hyperoxygenation Test • Apply 100% oxygen for 10 minutes • Measure postductal ABG • If the PaO2 < 150mm Hg – CHD • If Pa)2 > 150mm Hg – Pulmonary Disease

  10. How to tell if a lesion has ductal flow? • What about pre- and post- ductal sat differences? • Minimum of 3% difference indicates a duct-dependent lesion (typically > 5%)

  11. ToF

  12. TGA

  13. TAPVR

  14. PAPVR

  15. Coarctation

  16. Ebstein’s

  17. Initial Management • Arrange for Transfer • Initiate Prostaglandin E1 IV to keep PDA open • Should be given in any cyanotic infant • Starting dose: 0.05mcg/kg/min (often lower) • Side effects: • Apnea (12%), Hypotension, Hyperthermia (14%), Hypoglycemia, Tachycardia, Bradycardia, Seizures, Flushing (10%) Be Prepared to Intubate

  18. TetSpells • Unclear etiology • RVOT/infundibular spasm • Right to Left Shunting • Presentation: • Profound cyanosis • Respiratory distress • Grunting, fussiness and agitation

  19. Tet Spells • Treat in step-wise fashion: • Oxygen • Knee-chest position • Morphine • B-blockade • Phenylephrine Call Cardiology

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