EXAM #2: CARDIAC EMERGENCIES IN CHILDREN

Question 1

What are Dr. Mooridian’s D and E in resuscitation?

Answer 1

D= draw labs or give drugs 
E= Echo

Question 2

What labs should you draw for a sick child?

Answer 2

1) Blood gas
2) CBC
3) CMP
4) Blood culture

Question 3

What drugs should you consider for a critically ill child?

Answer 3

1) Inotropes
2) Antibiotics
3) Sodium bicarbonate

Question 4

Case study #1, what is the ABG likely to show?

Answer 4

Metabolic acidosis

Question 5

What is the likely cause of acute cardiac decompenstation a few days after birth?

Answer 5

Closure of the PDA

Question 6

What is the more common cause of respiratory depression, tachycardia, and poor perfusion in a child–NOT cardiac decompensation?

Answer 6

Sepsis

Question 7

What does a “critical” left-sided obstruction imply?

Answer 7

Ductal patency is required for systemic output

Question 8

What is the immediate management plan for left-sided heart obstruction?

Answer 8

1) PGE1
2) Inotropic support
3) Correct metabolic acidosis
- IV fluid
- Sodium bicarbonate

Question 9

Should the patient with left-sided obstruction be given oxygen?

Answer 9

NO!!!

Oxygen is a pulmonary vasodilator, which will DROP pulmonary vascular resistance needed to shunt blood from right-to-left

Question 10

What is the definitive therapy for left-sided obstruction?

Answer 10

1) Balloon valvuloplasty/ angioplasty

2) Surgery

Question 11

Read case #2. What is going on?

Answer 11

Critical right-heart obstruction

Question 12

What is the immediate management for right-sided heart obstruction?

Answer 12

1) PGE1
2) Inotropic support
3) Correction of metabolic acidosis

*Oxygen may or may not be helpful

Question 13

What should you turn to if echo is normal in case #2?

Answer 13

Inhaled NO–PVR is too high and this will lower it

Question 14

What is definitive treatment for right-sided obstruction?

Answer 14

1) Balloon valvuloplasty
2) Surgical valuloplasty
3) BT shunt

Question 15

Read case #3. What is likely going on here?

Answer 15

Arrhythmia (SVT)

Question 16

What is the common etiology of SVT in children?

Answer 16

• Underlying CHD

- S/p heart surgery from scar tissue leading to electrical abnormality

Question 17

Where does adenosine work to treat SVT?

Answer 17

Transient block of the AV node

Question 18

What are the conditions that allow for the development of a complete heart block in a child?

Answer 18

1) Child born to mother with SLE
2) Iatrogenic i.e. post-surgical
3) Inflammatory/infectious disease

Question 19

What is the treatment for complete heart block?

Answer 19

• External pacing (short-term)

- Implantable pacemaker

Question 20

Read case #4. What is going on?

Answer 20

Cardiac tamponade

Question 21

What causes cardiac tamponade in children most often?

Answer 21

1) Post-surgical

2) Malignancy

Question 22

What is the treatment for cardiac tamponade?

Answer 22

1) Stop bleeding
2) Anti-inflammatory
3) Pericardiocentesis

Question 23

Read case #5. What is going on?

Answer 23

Pleural effusion

Question 24

What are the treatments for Chylothorax?

Answer 24

1) Pleurocentesis
2) NPO
3) IV diuretics
4) Octerotide

Question 25

Read case #6. What is going on here?

Answer 25

Clot in the BT shunt