Pediatric emergency medicine trisk 1717 1717
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (74.65 KB, 1 trang )
Respiratory or other intercurrent, noncardiac illnesses are very concerning and
may be fatal. Nasogastric tubes should be placed with caution to avoid significant
vagal stimulation. Coronary blood flow may be compromised in some patients,
leading to acute heart failure and/or ventricular arrhythmias. Management of
these patients in the ED should be expedited and cardiology consultation should
be obtained prior to discharge. Caution should be used even when the infant is
well appearing.
Postpericardiotomy syndrome (PPS) is a postsurgical syndrome of fever,
pericardial and pleural inflammatory response, with effusions and malaise. It
usually occurs one to several weeks after open-heart surgery, cardiac
catheterization, or transvenous device implantation. The etiology is thought to be
an autoimmune reaction. If pericardial fluid accumulates rapidly, it may present
as cardiac tamponade.
If PPS is suspected, evaluate for leukocytosis and eosinophilia on CBC.
Echocardiogram can detect pericardial fluid and assess for tamponade. PPS is
treated with salicylates and pericardiocentesis if needed. Steroids are indicated if
salicylates are not effective or the effusion is large.
Pleural effusions may be seen acutely after discharge from the hospital
following any type of congenital heart surgery. Chylous or serous effusions may
be chronic following Fontan procedure (caval pulmonary anastomosis) due to
increased central venous pressures (lymphatic congestion).
Postoperative cardiac patients may present to the ED with wound infection,
sepsis, endocarditis, and/or mediastinitis. Sepsis presents with fever or florid
septic shock and occurs in 2.6% of patients after cardiac surgery. The usual
pathogens are group A beta-hemolytic Streptococcus, Escherichia coli, Listeria
monocytogenes, Staphylococcus aureus, and Pseudomonas aeruginosa.
Endocarditis presents with nonspecific symptoms of fever, poor feeding, and
malaise. High-risk situations for endocarditis include the presence of an abnormal
aortic valve, residual VSD, TOF, and extensive repairs involving foreign material
such as prosthetic valves. Atrial septal defects and right-sided defects are at lower
risk for endocarditis. A new murmur may develop from dehiscence of a
patch/conduit or turbulent flow caused by vegetations. Common pathogens
implicated in endocarditis include Staphylococcus aureus, Streptococcus
pyogenes, and Streptococcus viridans (Chapter 94 Infectious Disease
Emergencies ).
Mediastinitis is a serious postoperative complication that presents with local
erythema, pain, induration, fluctuance, and purulent drainage from the sternotomy
incision. This local infection may cause wound dehiscence and sternal instability.
