CCP Fall 2013 - Week 6
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What are the Signs & Symptoms of Tension Pneumothorax?
- Severe respiratory distress/dyspnea
- Decreased or absent breath sounds
- Tracheal Shift
- Late sign on external exam
- Early sign on radiographic
- SQ air
What are the landmarks for the acceptable needle thoracostomy sites?
- 2nd intercostal space, mid-clavicular or4th or 5th intercostal space, mid-axillary line
What are the landmarks for tube thoracostomy placement?
4th intercostal space anterior axillary line
What should be delayed as long as possible when pt is potentially experiencing a tension pneumothorax?
What are the signs & symptoms of massive hemothorax?
- Hypovolemic shock
- Altered mentation
- Decreased/absent breath sounds
- Midline trachea
- Flat neck veins
How do you treat a massive hemothorax?
- Tube thoracostomy
- Crystalloid replacement
- Blood replacement
What are the signs & symptoms of an open pneumothorax?
- Sucking chest wound
- Respiratory distress
What is the treatment for an open pneumothorax?
- Occlusive dressing
- Placed upon end exhalation
- Taped on 3 sides only until tube thoracostomy accomplished
- Seal 4th side post-chest tube
What are the signs & symptoms of flail chest?
- Paradoxical movement
- Uncommon in spontaneous breathing
- Common w/NMBA’s
- Respiratory distress
- Tachypnea w/grunting
- Accessory muscle use
- C/O severe chest pain
What are the treatments for flail chest?
- Attempt to stabilize flail segment
- Consider intubation w/peep
- Injured side down
- Limit fluids as able
- Opioids for pain PRN
What are the signs & symptoms of early tamponade?
- Sinus tachycardia
- Pulsus paradoxus
What are the signs & symptoms of late tamponade?
- Severe hypotension
- Beck’s triad Muffled heart tones
- Narrowed pulse pressure
What is the treatment for early tamponade?
- Force fluids
- Anticipate tamponade progression
What is the treatment for late tamponade?
What are the signs and symptoms of aortic rupture?
- Severe Chest/Mid-scapular pain
- HTN in the upper extremities
- Harsh systolic murmur
- CXR findings: Widened Mediastinum
Describe the treatment of aortic rupture
- Supportive: If caval or liver lac suspected, est IV access above & below the diaphragm
- Rapid transport to thoracic surgeon
Describe the clinical presentation of diphragmatic rupture
- Bowel sounds in chest
- Scaphoid abdomen
Describe the treatment of diaphragmatic rupture
- NGT / OGT
- Strict NPO
- ETI / PPV PRN
Describe the presentation of tracheobronchial disruption
- Continuous air leak or persistent pneumothorax
- Rapidly progressing subcutaneous emphysema
Describe the treatment of tracheobronchial disruption
- Consider mainstem intubation trial
Describe the clinical presentation of esophageal perforation
Describe the treatment of esophageal perforation
- NGT / OGT
What is Newton’s 1st Law?
An object in motion will remain in motion and an object at rest will remain at rest, unless acted upon by a force
What is Newton’s 2nd Law?
F = MA
What is Newton’s 3rd Law?
For every action there is an equal and opposite reaction
Describe injuries common to head-on collisions w/an up-and-over path of the body
- Head injuries
- Axial loading on the neck
- Chest injuries from steering wheel
- Pelvis injuries from belt
Describe injuries common to head-on collisions w/an down-and-under path of the body
- Acetabular fx
- Femur fx
- Pelvic fx
- Low back injuries
- Chest & facial injuries from steering wheel
Describe predictable injury patterns suffered in rear end collisions
- T12-L1 back injuries
- Femur fx
- Tib/Fib fx
- Ankle Fx
- C2 fx of neck
- Evaluate for 2nd impact injuries
What are the 2 most common spinal injuries?
What type of collision causes the most lethal injuries?
What is indicative of adequate oxygenation in trauma management?
SpO2 > 90%
How do you assess for adequate ventilation in trauma management?
Which VS is more more likely to alter 1st in the trauma patient?
HR - BP won't fall until EBL > 30-40%
Describe reasons for increased risk pattern in farming accidents
- Delayed arrival of medical care & extrication often increase mortality
- High potential for HAZMAT involvement
Describe why tractor (farm) accidents raise the index of suspicion for MOI
- Tractors are much heavier than autos
- Tractors have a high center of gravity making them prone to rollovers
- End over end rollovers have a greater potential for pt entrapment
What age groups statistically suffer more falls?
Primarily in adults & children under 5
What part of a child's body will impact 1st in a fall?
Impact on their head
How do adults injure themselves in a fall?
“Lover’s Leap”: Victim impacts on feet then falls backwards landing on buttocks & outstretched hands
What injuries are common d/t the sequence of impacts often suffered in falls by adults?
- Fx of feet/legs
- Hip & pelvic injuries
- Axial loading to the lumbar & cervical
- Vertical deceleration forces on organs
- Colle’s fxs of the wrists
What are general areas of concern in impalements / stab wounds?
- Area of body penetrated
- Blade length
- Angle of penetration / attacker sex
What are general areas of concern in GSWs?
- Type of weapon
- Caliber, handgun vs long gun
- Distance from weapon
- Bullet construction
- High velocity bullets travel @ > 2000 fps
How many distinct injury profiles can a victim experience from a blast?
3: Primary, Secondary & Tertiary
Describe the injury pattern seen in a Primary Injury from a Blast
Result of Initial air blast, causes Injuries to air containing organs
What causes the injury pattern seen in a Secondary Injury from a Blast?
Victim struck by projectiles launched by blast force
What causes the injury pattern seen in a Tertiary Injury from a Blast?
Victim impacting the ground or another object
What is the primary concern in a burn patient?
What common byproducts of combustion complicate burn management?
The combustion of what material results in the release of cyanide gas?
Petroleum products, esp household carpet
What is the goal of fluid resuscitation in the adult (child) burn patient?
Urinary output of 30-50 ml/hr (1-2 ml/kg/hr in peds)
What is the Parkland Burn Formula?
- 4 mL*kg*%BSA burned = VTBI
- Give 1/2 over the 1st 8 hrs post burn
- Give the remaining 1/2 over the following 16 hrs
What is the Consensus Formula for burn pt fluid resuscitation?
2-4 mL*kg*%BSA burned
How do you calculate burn mortality?
- Age ÷ % BSA Burned = Mortality %
- Add 20 if respiratory involvement
What is the treatment paradigm for hydrofluoric acid burns?
- Copiuos water
- 10% Calcium Gluconate
What is the treatment paradigm for alkali metal burns (Na & K)?
- Water reactive
- Absorb heat w/oil
What process generally limits the depth of acid burns?
Describe the mechanism of alkali burns
Alkalis dissolve protein & collagen causing dehydration & saponification
- Conversion into soap. It is the hydrolysis or the splitting of fat by an alkali yielding glycerol & 3 molecules of alkali salt of the fatty acid, the soap.
- Hydrolysis of an ester into its corresponding alcohol & acid (free or in the form of a salt).
Generally, which causes more severe burns, acids or alkalis?
What are the 2 modes of EMS @ a HazMat scene?
- Fast Break
- Long-Term decision making
Describe the "Two-Step" Decon process
- Usually at a fast break scenario
- Remove all clothing, shoes, jewelry
- Wash & rinse patient w/soap & water making sure they do not stand in runoff
- Reposition out of runoff & repeat a 2nd time
What byproduct of massive muscle damage 2° to electrical injury will result in ATN & renal injury failure?
Describe the clinical management of myoglobinuria 2° to electrical injury
- Maintain urine output of a MINIMUM 100 ml/hr w/fluids
- Osmotic diuretics
- Alkalinize the urine w/bicarb solutions
Describe the Respiratory assessment for START Triage
- Immediate: Abnormal rate, WOB or respiratory distress
- Delayed: Normal respiratory pattern or agonal
- Dead: Apneic
Describe the Perfusion assessment for START Triage
- Immediate: Cap Refill > 2 sec
- Delayed: Normal Cap Refill
- Dead: Pulseless
Describe the Mentation assessment for START Triage
- Immediate: Altered LOC
- Delayed: Conscious, A&O x 3
- Dead: Injuries incompatible w/life
How long should a START Triage assessment take for each pt?
What can you do in START Triage if patient is apneic?
- Reposition the head once
- If spontaneous resps resume, pt is triaged immediate
- If spontaneous resps do NOT resume, pt is triaged dead
How is penetrating trunk trauma classified according to START Triage?
An emergency responder is injured at the scen of an MCI. According to START Triage, what is their designation?
- ImmediateAll responders injured at an MCI are triaged immediate
Where is cap refill assessed in START Triage?
How are Erythrocytes listed on lab reports?
How are Leukocytes listed on lab reports?
How are Thrombocytes listed on lab reports?
How is Hemoglobin listed on lab reports?
- Hemoglobin is the O2 binding protein in RBCs
How is Hematocrit listed on lab reports?
- Hematocrit is the percentage of blood that is not fluid
- Fluid part of the blood
- 91% is H2O
- 7% are proteins (Primary is Albumin @ 60%)
What is a normal lab value for RBC?
What is a normal lab value for Hgb?
What is a normal lab value for Hct?
What is a normal lab range for WBC?
5k - 10k
What is a normal lab range for Plt?
150k - 400k
What is a normal lab range for Na+?
135 - 145
What is a normal lab range for K+?
3.5 - 5.0
What is a normal lab range for Cl-?
95 - 107
What is a normal lab value for BUN?
What is a normal lab value for Creat?
Blood loss is replaced by isotonic crystalloid by iv @ what ratio?
3 : 1
At what value should MAP be maintained w/fluids?
Describe the process of bleeding control
- Vessel spasm upon injury to tissue themselves
- Platelet plug development (primary hemostasis)
- Platelets attach to exposed collagen vi von
- Willebrand’s factor (vWF)
- Clotting cascade activation by platelets triggered secretion of thromboxane A2 (TXA2) [location of ASA & NSAID interference]
- Clot formation occurs (secondary hemostasis)
- Clot retraction closes vessel approximately 20 min to 1 hr later
How is the intrinsic pathway of clotting cascade activated?
- Triggered by endothelial damage w/collagen
- exposureVessel damage
How is the extrinsic pathway of clotting cascade activated?
- Triggered by tissue damage w/tissue thromboplastin release
- Highest quantities in
What mineral is essential at several steps along the clotting pathway?
Calcium essential at numerous steps along the pathway
Describe Disseminated Intravascular Coagulopathy (DIC)
- Sepsis, massive tissue trauma &/or hypoxia causes systemic activation of clotting cascade by overwhelming release of tissue thromboplastin (tissue factor).
- Problem resides w/clotting ultimately.
- MODS & death result from entire systems losing blood flow d/t mass micro emboli occlusion.
How is DIC diagnosed?
- Diagnosis is based on clinical presentation
- + D-Dimer
- Low clotting factors (fibrinogen) & platelets
- High PT, aPTT, INR & FSPs
How do we treat DIC?
Focus on treating the precipitating event
When should PRBCs be administered?
Given to ⇧ O2 carrying capacity of blood ONLY
Above what Hgb level are PRBCs NOT indicated?
> 10 mg/dl
Below what Hgb level are RBCs indicated?
< 6 mg/dl
At what Hgb level should pts receive PRBCs prior to proceeding to altitude (flight)?
How fast SHOULD PRBCs be given?
- Over 2-4 hrs
- Can be given fast emergently, but RBC lysis increases under pressure
Are ABO antigens a concern when administering PRBCs?
Yes, watch for acute hemolytic reactions (temp & back px)
What blood type is considered the universal donor?
What blood type is considered the universal recipient?
What is the volume of 1 unit of PRBCs?
What is the pediatric dosing for PRBCs?
When does citrate toxicity become a concern?
- Multiple units &/or fast push (4 units < 20 min)
- [> 1 ml/kg/min]
How much will 1 unit of PRBCs impact a patient's H&H?
Raise it by 1 & 3
How is temperature a concern when administering PRBCs?
- Need to re-warm the PRBCs.
- Every unit PRBCs given @ storage temp will drop core temp 0.25°C
- Hypothermic pts don't clot!
What should be administered concurrent with PRBCs?
Equal volumes of NS
What concerns re K+ arise during blood admin?
- Admin rates > 90-120 ml/min can cause clinically significant hyperkalemia & arrest
- Watch ECG for Δs, if seen stop blood immediately & consider NaHCO3-, Dextrose & Insulin as appropriate
What is the pathology of a hemolytic reaction?
Describe the signs & symptoms of a hemolytic reaction?
- Back pain
How quickly will a hemolytic reaction develop?
Shortly after transfusion
What is the treatment for a hemolytic reaction?
- Stop transfusion
- Supportive care
What is the treatment for an anaphylactic reaction to blood transfusion?
- Stop transfusion
What is the treatment for a febrile reaction to blood transfusion?
What is the treatment for circulatory overload secondary to blood transfusion?
What percentage of acute hemolytic reactions will develop DIC?
Describe the treatment of acute hemolytic reaction
- Treatment focuses on:
- Support hemodynamics w/fluids & pressors
- Maintain renal perfusion & function w/fluids & diuretics
- Prevention of DIC: Maintain pressure & oxygenation
What are the indications for FFP administration?
- Coumadin therapy reversal
- Antithrombin III deficiency
- S/P extended heparin therapy
- Dilutional coagulopathy (> 1 blood volume of replacement [10 units of PRBCs]
- Commonly given 1:4 w/PRBCs until 10 units of PRBCs then 1:1
- May be given as a volume expander or for coagulation factors
What is platelet infusion indicated for?
- Platelet deficiency
- ASA Guidelines: “platelet transfusion is rarely indicated when platelet count is greater than 100,000 and is usually indicated w/a count below 50,000”
What equipment requirements are there for platelet administration?
Use a filter w/a 19 ga or larger needle
How much will 1 unit increase the platelet count?
Cryoprecipitate has high levels of what?
When is cryoprecitiate given?
- Hemophilia A
- von Willebrand Disease (vWD)
- Stop tPA induced bleeding
What is the normal infusion rate for cryoprecipitate?
What is the normal adult dose for cryoprecipitate?
What are the most common indications for emergent cryoprecipitate administration?
- Massive PRBC infusions
- tPA related bleeding
What components make up cryoprecipitate?
- Factor VIII:C
- Factor XIII – Fibrinogen stabilizing factor
- von Willebrand factor
How is the rib cage of a child different than an adult?
More elastic & flexible
How does a child's lung tissue compare to n adult's?
Compare the mediastinum of a child to that of an adult
The child's mediastinum is more mobile
Compare the bones of the skull of a child to that of a patient older than 5 YOA?
Soft & separated by cartilage until 5 YOA
When do the fontanelles close in a child's skull?
- Anterior closes @ 12-18 mos
- Posterior closes by 2 mos
Compare the liver & spleen of a child to an older patient
- Proportionally larger
- More vascular
How are the bones of a child different than those of an older patient?
They are softer
Compare the cardiac output of a child to that of an adult
At what point will hypotension present in the case of a child with acute blood loss?
Children will not demonstrate hypotension until acute blood loss totals ~ 25% of the circulating blood volume
Compare the surface area to volume ratio of a child to that of an adult
- Larger ratio of surface area to volume: This
- influences heat loss primarily
What are the 3 components of a pediatric assessment?
- Perfusion Status
- Work of Breathing
How does the tongue in a child's mouth differ than that of an adult?
A child's tongue takes up more room in the mouth
Describe the epiglottis of a child in relation to the airway
Short, narrow & angled away from the long axis of the trachea
Describe the anatomical differences in a child's airway
- Larynx is higher
- Short chin gives more anterior relationship
Where is the narrowest portion of the airway in a child < 10 YOA?
@ the cricoid cartilage
Compare O2 consumption in an infant to that of an adult
O2 consumption in infants = 2x that of an adult
What size tube should be used to intubate a pre-term infant?
2.5 - 3.0
What size tube should be used to intubate a term infant?
3.0 – 3.5
What size tube should be used to intubate a 3 MOA - 1 YOA infant?
4.5 - 4.0
What formula solves for the size tube used to intubate a pediatric patient > 1YOA?
What is the depth of insertion when intubating a pre-term neonate < 1000 gm in mass?
What is the depth of insertion when intubating a pre-term neonate btn 1000 gm & 2000 gm in mass?
7 - 9 cm
What is the depth of insertion when intubating a term neonate?
What is the depth of insertion when intubating a 1 YOA child?
What is the depth of insertion when intubating a 2 YOA child?
What is the formula for determining depth of insertion when intubating a child older than 2 YOA?
- 3 x ETT Size or
- (Age/2)+ 12
Describe the anatomical presentation of Pierre Robin
- Short Chin
- Antero/superior glottis
- Arched cleft palate common
Describe the anatomical presentation of Treacher-Collins
- Short chin
- Dental malformations
Describe the anatomical presentation of Hurler’s Syndrome
- Short neck
- Scoliosis common
Describe the anatomical presentation of Goldenhar Syndrome
- Facial asymmetry
- Small mouth/limited opening
What is the bolus dose for a child?
20 mL/kg then reassess, repeat PRN
What is the IV bolus dose for an infant/neonate?
10 mL/kg then reassess, repeat PRN
What is the Estimated Blood Volume (EBV) of a child > 1 YOA?
What is the Estimated Blood Volume (EBV) of a child 3 mos - 1 YOA?
What is the Estimated Blood Volume (EBV) of a term neonate?
What is the Estimated Blood Volume (EBV) of a premature neonate?
What is the formula to calculate Maximum Allowable Blood Loss in a child?
What is the minimum acceptable Hct for the flight environment?
Describe the formula for calculating IV Maintenance Infusion rates for children
- 4 /2 /1 System4 ml/kg for the 1st 10 kgs of mass
- 2 ml/kg for the 2nd 10
- 1 ml/kg for every kg over 20
Describe continuous monitoring guidelines for pediatric patients
- Continuous skin temp monitoring recommended, esophageal / rectal probe optimal
- Continuous SPO2 monitoring: “Standard of care”
- Glucose monitoring PRN
What is considered hypoglycemia in a neonate?
- < 30 mg/dl
- Use D10 to correct
What is considered hypoglycemia in a child?
- < 40 mg/dl
- Use D25 to correct
What is the optimal IV fluid for children < 2 YOA?
- NSKidneys are better able to deal w/excess Na+
What is the pediatric dose for synchronized cardioversion?
What is the pediatric dose for defibrillation?
2 J/kg then 4 J/kg
What is the pediatric dose of adenosine?
0.1-0.2 mg/kg rapid IVP
What is the pediatric dose of atropine?
0.02 mg/kg IV min 0.1 mg max 0.5 mg
What is the pediatric dose of dobutamine?
2-20 mcg/kg/min IV gtt
What is the pediatric dose of dopamine?
2-20 mcg/kg/min IV gtt
What is the pediatric dose of epinephrine?
- 0.01 mg/kg IV 1:10,000
- 0.1 mg/kg ET 1:1000
- Infusion: 0.1-1.0 mcg/kg/min IV gtt
What is the pediatric dose of lidocaine?
What is the pediatric dose of naloxone?
- < 20 kg: 0.1 mg/kg IV
- > 20 kg: 0.4-2.0 mg IV
What is the pediatric dose of sodium bicarbonate?
- 1 mEq/kg IV or
- 0.3 mg x kg x base deficit IV
Describe Wadell's Triad
- Common Injuries when a child is struck by a motor vehicle:
What is the single largest cause of pediatric traumatic death?
Motor vehicle related accidents
What is the most common non-accidental-trauma pediatric injury type?
What system is injured the most in non-accidental-trauma?
What type of injuries best demonstrate long term abuse?
What injuries are sustained during sexual abuse of a child?
Describe a comminuted fracture
Bone is broken into fragments
Describe a compound fracture
Bone is broken & piercing the skin
Describe a compressed fracture
One bone is forced against another
Describe a displaced fracture
The ends of the bone are not aligned
Describe a greenstick fracture
Periosteum divided on only 1 side
Describe a pathological fracture
Occurs because of a bone defect
Describe a simple fracture
Fracture is straight & in good alignment
Describe a spiral fracture
Fracture resulting from twisting motion
Isolette use is recommended in what group of patients?
< 10 lbs or 30 days (corrected age)
What neuro Δs can you expect w/temp Δs?
What perfusion status Δs can you expect w/temp Δs?
- Hot: Tachycardic
- Cold: Bradycardic & hypotensive
What physiologic changes occur w/each ° ⇧ in temp?
Is ASA an acceptable febrile therapy for children?
No, d/t Reye's syndrome
Describe techniques to keep children warm
- Pre-heat the ambulance
- Keep dry, head covered
- Warm gases via ETT
- Caution w/commercial heat packs
- Plastic or aluminum foil use: Around towel or cellophane wrap
- Warmed saline gauze over open defects
- Fluid warmer
Describe standards of care when mechanically ventilating an infant
- Pressure targeted ventilation
- SpO2 & ETCO2 monitoring
What are the vent settings for an infant?
- FiO2: 100%
- Inspiratory Time (IT): > 0.5 sec
- Rate: 16 – 40
- PEEP: 0 – 5 cm
- PIP: 15 – 20 cmH2O
Describe standards of care when mechanically ventilating a child
- Volume targeted ventilation typical after 6 mos of age
- SpO2 & ETCO2 standard of care
What are the vent settings for a child?
- FiO2: 100%
- Tidal Volume (Vt): 6 – 12 mL/kg
- Rate: 16 – 24
- PEEP: 0 – 5 cm
- PIP: < 30 - 40 cmH2O
What are common causes of pediatric seizures?
Are tonic-clonic seizures common in the pediatric pt population?
Rarely seen d/t immaturity of nervous system
Describe subtle seizures as seen in the pediatric population
- Repetitive mouth/tongue movement
- Eye deviation
- Repetitive blinking
Describe clonic seizures as seen in the pediatric population
Repetitive jerky movements of limbs
Describe tonic seizures as seen in the pediatric population
May resemble posturing or tonic extension seen in older pts
Describe myoclonic seizures as seen in the pediatric population
Multiple jerking motions, usually of the upper extremities
Describe the clinical treatment for neonatal diaphragmatic hernia
- Intubation for resp distress; PPV as indicated
- OGT w/suction
What is the essential issue with choanal atresia?
What is the treatment for choanal atresia?
- Provide oral airway access
- ETT w/o ventilation possible but pressure support may be needed
What are the concerns w/neonatal aspiration pneumonia?
- Meconium staining
- ET suctioning acceptable but discouraged unless lethargic
- Consider risk of TEF: Minimize PPV
- If brisk, monitor only
What are the 2 classes of Congenital Hert Disease?
- Acyanotic Lesions
- Cyanotic Lesions
Describe Acyanotic Lesions
- Blood returning to the RA has passed through the lungs like normal
- Many of these present w/pulmonary overload & CHF / Pulmonary edema symptoms
Name some Acyanotic Lesions
- PDA: Anticipate in low birth weight neonates, delayed closure in premies
- Coarctation of the Aorta
- VSD Very common in Down’s Syndrome, ESP males
- Commonly coexistent w/Coarcs & PDAs The most common CHD
- Aortic Stenosis: More common in males
- Pulmonary Stenosis
Describe Cyanotic Lesions
Any condition w/true “mixing” of oxygenated & unoxygenated blood. Commonly causes a cyanotic appearance.
Left shunt w/systemic hypoxia
- Commonly PDA dependent
- These lesions can cause a Right ⇨
- Typical SaO2 is 75-85%
Name some Cyanotic Lesions
- Transposition of the great vessels
- Tetrology of Fallot
- Total Anomalous Pulmonary Venous Return (TAPV)
- Truncus Arteriosus
- Tricuspid Atresia
- Hypoplastic Left Heart Syndrome
Describe the therapeutic approach to treating Cyanotic Lesions
Minimize/avoid any stimulus to cough (suctioning, pain, acidosis etc) to prevent pulmonary hypertensive crisis & subsequent increased right ⇨ left shunting
What is the most common Congenital Heart Disease?
Ventricular Septal Defect (VSD)
Identify transport considerations for pts w/CHDs
- Pressurized cabin is essential
- Specialty teams should be utilized whenever
- For longer transports Nitric Oxide should be considered / available
- NO air in IV lines
- Monitor SpO2, EtCO2 & electrolytes as closely as able
- Specific repairs (i.e. Blalock Taussic Shunt, aka BT Shunt) prevent use of affected arm for BPs & IVs
Describe the normal closure of a patent ductus arteriousus (PDA)
Functionally closes at birth, anatomically closes by 21 days old
Describe the effect of a patent ductus arteriousus (PDA)
- Creates Left ⇨ Right shunt
- Potential for gross pulmonary edema & resp failure
Describe therapy to close a PDA
- Indomethagin (PGE1 inhibitor)
Describe therapy to maintain a PDA
Describe "Transposition of the Great Vessels"
- Aorta & the Pulmonary Artery are reversed
- Cyanotic heart disease
Patients with Transposition of the Great Vessels are dependent for their survival on at least 1 other CHD. What other CHDs support this condition?
Ventricular Septal Defects (VSDs) may have an audible murmur. What information may the murmur reveal?
Murmur amplitude may indicate size (inverse relationship)
What mechanism reverses the left ⇨ right shunt of a VSD?
Hypoxic Pulmonary Vasoconstriction Response (HPVR)
Describe treatment of a VSD
- Pre-load reduction
- Diuresis (furosemide [Lasix®] utilized most often @ 0.5 – 1.0 mg/kg)
Describe Coarctation of the Aorta
- Narrowing of the aortic arch typically just distal of the left subclavian bifurcation, commonly @ aortic hiatus of diaphragm
- Acyanotic Heart Disease
- Decreased aortic flow results in increased LV pressures & ultimately failureCommonly associated w/VSD
Describe treatment of Coarctation of the Aorta
- Minimize SVR as able
- Prevent valsalva
- Treat symptoms
- Monitor SpO2 on right hand for accuracy
What 4 defects make up the Tetrology of Fallot?
- PA Stenosis
- RV Hypertrophy
- Rightward displacement of aorta exploited by VSD
Describe the pathophysiology of Tetrology of Fallot
- Right ⇨ Left shunt
- Cyanotic heart disease
Describe the treatment of Tetrology of Fallot
- PGE1 for PDA patency management
- “Tet Spell” management
- Knee-chest positioning
- O2: Careful, PDA management
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