Pediatric emergency medicine trisk 1714 1714
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As soon as cardiac pathology is suspected consult a pediatric cardiologist.
Consult cardiac surgery early if extracorporeal membrane oxygenation (ECMO)
or surgical intervention is anticipated.
Management/Diagnostic Testing of an Infant With Cyanosis and Suspected
Ductal Dependent Lesion. The presentation of cyanosis due to ductal dependent
lesions is variable since ductal dependent lesions exist along a spectrum. If
cyanosis is the predominant symptom, first administer 100% oxygen. Oxygen
supplementation will not improve cyanosis due to cardiac causes but pulmonary
causes should respond. Oxygen administration may be diagnostic as well as
therapeutic in the stable patient. The hyperoxia test can help differentiate cardiac
from pulmonary disease. After receiving 100% oxygen for 10 minutes, an ABG is
tested. PO2 greater than 150 mm Hg is normal. PO2 less than 100 mm Hg
suggests cardiac etiology. Pulse oximetry should not be used for the hyperoxia
test.
The treatment of cardiac cyanosis hinges on re-establishing PBF by opening
the DA using PGE1 (0.05 to 1 µg/kg/min) as discussed above. Endotracheal
intubation and mechanical ventilation will protect the infant from apnea, a
common side effect of PGE1 .
A hypercyanotic spell (Tet spell) is a cyanotic emergency, which may result in
altered mental status, loss of consciousness, or death. Events are typified by
hyperpnea, tachypnea, and agitation. It occurs when a patient with TOF or similar
