Peds cardiac Emergencies

Question 1

Waht is Total anomalous venous return?

Answer 1

Pulmonary Veins cant get back to the Left Atriun/Ventricle.

Need a shunt before they leave the hospital.

Question 2

What makes the major difference in history in TAPVR?

Answer 2

Whether or not there is a Venous obstruction present

Question 3

What is the Surgical Management of TAPVR?

Answer 3

Reconnect pulmonary venous confluence to the back of the left atrium. Hard to do since everything is behind the heart!

Question 4

What is the last Vital sign to change is Shock?

Answer 4

BP is the last to fall!

Question 5

What are the ABCDEs of Resuscitation?

Answer 5

Airway
Breathing 
Circulation
Draw Labs 
-Blood Culture, blood gas, CBC, CMP
-Inotropes, antibiotics, Na Bicarb
Echocardiogram

Question 6

What can cause Cardiogenic Shock at 5 days of age?

Answer 6

Ductus arteriosus closed

Question 7

What are the possible causes of left sided Obstruction?

Answer 7

Critical Aortic Stenosis
Critical Coarctation of the Aorta
Hypoplastic Left Heart

Question 8

What are the Effects of left sided Obstruction?

Answer 8

LV obstruction
LA Dilation
Pulm Venous Congestion
L to R shunt across atrial septum

Question 9

Why should High O2 be avoided in Left sided obstruction?

Answer 9

Will cause pulmonary vasodilation

YOu want more blood in the systemic circulation, not the Lungs!!!

Question 10

What are the causes of Right Sided Obstruction?

Answer 10

Pulmonary Atresia
Critical Pulmonary Stenosis
Tricuspid Atresia

Question 11

What are the effects of Right Sided Obstruction?

Answer 11

Right atrial Dilation

Right sided Heart Failure

Question 12

What is the immediate management of RSO?

Answer 12

PG E1 via continuous IV infusion
Inotropic Support
Correction of Metabolic Acidosis

Question 13

What are The Definitive and palliative therapies in RSO?

Answer 13

Baloon/Surgical Valvuloplasty

Aorto-pulmonary Shunt
Blalock-Taussing

Question 14

What are the causes of Inadequate mixing?

Answer 14

D Transpostion
Tricuspid Atresia + Restrictive ASD
Pulm Atresis + Restrictive ASD
HLHS + Restrictive ASD

Question 15

What type of Tachycardia is most common in children?

Answer 15

Supraventricular Tachycardia

Question 16

What are rhe Charicteristics of WPW on ECG?

Answer 16

Short PR interval
Delta wave
Slurred R wave

Question 17

What are the Medical managements of SVT?

Answer 17

Increased vagal tone
-Valsalva
-Gag reflex
-Ice to the forehead
Related to patients age

Question 18

What is Adenosine used for?

Answer 18

Blocks conduction through AV node

If this is unsuccessful or if unstable then use electricity

Question 19

What are the Short Term and Long term Therapies for SVT?

Answer 19

Shock

Meds
Beta Blocker
Digoxin
Ca Channel Blocker
Amiodarone
Ablation procedure

Question 20

What is the Clinical Presentation of Complete Heart Block?

Thaerapy?

Answer 20

Bradycardia
CHF
Some asymptomatic

External pacing
implantable pacemaker

Question 21

What is the cause of Muffledheart sound?

Answer 21

Pericardial effusion/Tamponade

Question 22

What are the therapies for a Cardiac Tamponade?

Answer 22

Pericardiocentesis
-needle or catheteter drainage of pericardial space
Correct the problem
-stop the bleed
Anti inflammatory meds

Question 23

What is a chylothorax?

Answer 23

Lymphatic fluid within the pleural space leaking from thoracic duct
Slow accumulation
Noonan syndrome
More common in complex, single ventricle lesions

Question 24

What size tube is used for a B-T shunt in newborns?

Answer 24

3.5 mm diameter

Question 25

What are the reasons for BT shunt obstructions?

Answer 25

Non-compliance with anti coagulation
Dehydration
Poor ventricular function
Elevated Pulmonary vascular resistance