Coarctation of Aorta
OVERVIEW
- congenital condition characterised by narrowing of the aorta near the site where the ductus arteriosus (ligamentum arteriosum after regression) inserts.
CLINICAL FEATURES
- presents 1 week into life (when duct closes)
- acyanotic heart disease
- shock
- poor pulses
- hyperlactaemia
INVESTIGATIONS
- ECHO: shows defect
MANAGEMENT
Resuscitate
A – intubate with attention to haemodynamics (fentanyl/ketamine with vasoactives ready)
B – ventilate
C – volume 10mL/kg +/- inotropes
Assess
- History – any signs of sepsis, antenatal, immunisations, siblings
- Examination – measure all limb pulses
- Investigations – serial lactates, sepsis screen
Treatment
- Specific: preductal arterial line, prostaglandin infusion to open duct 20ng/kg/min IV and titrate (can develop fever, hypotension and apnoea)
- General: NBM, urinary catheter, invasive monitoring, antibiotics
Disposition
- arrange urgent transfer to paediatric cardiothoracic hospital
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC