Crisis Management

Question 1

Hypercyanotic spell: pathophysiology

Answer 1

Increase PVR: infundibular spasm, high airway pressure&raquo_space; obstruct PBF

Decrease SVR: hypovolemia, acidosis, hypoxia

Question 2

Hypercyanotic spell: management 7 ข้อ

Answer 2

1. 100% O2
2. Knee-chest position or abdominal compression
3. IV crystalloid 15-30 ml/kg or colloid 5-10 ml/kg
4. Morphine 0.05-0.1 mg/kg: reduce stress
5. Beta-blocker: esmolol 0.5 mg/kg then 50-300 mcg/kg/min, PPN 0.1 mg/kg
6. Phenylephrine 0.5-2 mcg/kg or Levophed
7. NaHCO3 1-2 mEq/kg to correct metabolic acidosis, increase SVR, decrease PVR

Question 3

VAE management

Answer 3

1. Call for help + notify surgeon
2. Prevent air entry: flood site with NSS, fluid load, lower field below RA, sustained PAP
3. Reduce size: stop N2O, 100% O2, aspirate air via C-line
4. Overcome mechanical obstruction: Lt lateral or trendelenberg to force air buble above RVOT, inotrope support, chest compression if arrest

Question 4

Hyperkalemia Rx onset and duration

Answer 4

1. Ca gluconate: immediate, 30-60 min
2. Insulin: 20 min, 4-6 hr
3. Albuterol NB: 30 min, 2 hr
4. Furosemide: 15 min, 2-3 hr
5. NaHCO3: hours, duration of infusion
6. Hemodialysis: immediate, 3 hr