- Large VSD
- RV outflow tract obstruction
- RV hypertrophy
- Overriding aorta
- 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
- 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
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.