Tetralogy of Fallot
PATHOLOGY
- Large VSD
- RV outflow tract obstruction
- RV hypertrophy
- Overriding aorta
CLINICAL FEATURES
- often diagnosed antenatally
- “tet spell” -> cyanosis, pale, poorly perfused (infundibular spasm with no blood flow to lungs with right to left shunting across VSD)
- precipitating factors for a tet spell: hypovolaemia, acidosis, low Hb
MANAGEMENT
- FiO2 1.0
- vascular access (IV/IO)
- fluid bolus
- positioning: ask mum to hold baby -> will naturally bring knees up to chest
- morphine bolus: releases infundibular spasm + sedation decreases myocardial oxygen demand
- transfuse blood if HCT < 0.35
- consider vasoconstrictor such as metaraminol or beta-blocker if not responding to other treatments
- discuss with tertiary paediatric cardiologist
References and Links
- LITFL Paediatric Perplexity 003 — Newborn with Hyprcyanotic Episodes
- LITFL Cardiovascular Curveball 009 — Tetraology of Fallot and BT shunts
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