EXAM #2: CARDIAC EMERGENCIES IN CHILDREN Flashcards
What are Dr. Mooridian’s D and E in resuscitation?
D= draw labs or give drugs E= Echo
What labs should you draw for a sick child?
1) Blood gas
2) CBC
3) CMP
4) Blood culture
What drugs should you consider for a critically ill child?
1) Inotropes
2) Antibiotics
3) Sodium bicarbonate
Case study #1, what is the ABG likely to show?
Metabolic acidosis
What is the likely cause of acute cardiac decompenstation a few days after birth?
Closure of the PDA
What is the more common cause of respiratory depression, tachycardia, and poor perfusion in a child–NOT cardiac decompensation?
Sepsis
What does a “critical” left-sided obstruction imply?
Ductal patency is required for systemic output
What is the immediate management plan for left-sided heart obstruction?
1) PGE1
2) Inotropic support
3) Correct metabolic acidosis
- IV fluid
- Sodium bicarbonate
Should the patient with left-sided obstruction be given oxygen?
NO!!!
Oxygen is a pulmonary vasodilator, which will DROP pulmonary vascular resistance needed to shunt blood from right-to-left
What is the definitive therapy for left-sided obstruction?
1) Balloon valvuloplasty/ angioplasty
2) Surgery
Read case #2. What is going on?
Critical right-heart obstruction
What is the immediate management for right-sided heart obstruction?
1) PGE1
2) Inotropic support
3) Correction of metabolic acidosis
*Oxygen may or may not be helpful
What should you turn to if echo is normal in case #2?
Inhaled NO–PVR is too high and this will lower it
What is definitive treatment for right-sided obstruction?
1) Balloon valvuloplasty
2) Surgical valuloplasty
3) BT shunt
Read case #3. What is likely going on here?
Arrhythmia (SVT)
What is the common etiology of SVT in children?
- Underlying CHD
- S/p heart surgery from scar tissue leading to electrical abnormality
Where does adenosine work to treat SVT?
Transient block of the AV node
What are the conditions that allow for the development of a complete heart block in a child?
1) Child born to mother with SLE
2) Iatrogenic i.e. post-surgical
3) Inflammatory/infectious disease
What is the treatment for complete heart block?
- External pacing (short-term)
- Implantable pacemaker
Read case #4. What is going on?
Cardiac tamponade
What causes cardiac tamponade in children most often?
1) Post-surgical
2) Malignancy
What is the treatment for cardiac tamponade?
1) Stop bleeding
2) Anti-inflammatory
3) Pericardiocentesis
Read case #5. What is going on?
Pleural effusion
What are the treatments for Chylothorax?
1) Pleurocentesis
2) NPO
3) IV diuretics
4) Octerotide
Read case #6. What is going on here?
Clot in the BT shunt
