Pediatric Cardiology Emergencies

  • 8,329 views
Uploaded on

http://drzulalulger.blogspot.com

http://drzulalulger.blogspot.com

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
  • good presentation
    Are you sure you want to
    Your message goes here
  • thanx.................
    Are you sure you want to
    Your message goes here
  • Good presentation
    Are you sure you want to
    Your message goes here
No Downloads

Views

Total Views
8,329
On Slideshare
0
From Embeds
0
Number of Embeds
7

Actions

Shares
Downloads
527
Comments
3
Likes
6

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 1. Pediatric Cardiology Emergencies Jeffrey D. Schuster, M.D. Texas Tech University-El Paso
  • 2. Newborn Problems
    • Cyanosis
    • Low Cardiac Output
  • 3. Newborn Problems - Cyanosis
    • Cardiac Cyanosis
      • Does not respond to oxygen
      • Does not respond to ventilation
      • Usually no respiratory distress
  • 4. Newborn Problems - Cyanosis
    • Evaluation
      • Chest x-ray
      • Arterial blood gasses
      • Echocardiogram
  • 5. Newborn Problems - Cyanosis
    • Right sided obstructive lesions
      • Pulmonary atresia
      • Tricuspid atresia
      • Tetralogy of Fallot
  • 6. Tricuspid Atresia
  • 7. Newborn Problems - Cyanosis
    • Abnormal Circulations
      • Transposition of the great arteries
      • Total anomalous pulmonary venous return
  • 8. Transposition of the Great Arteries
  • 9. TAPVR
  • 10. Newborn Problems - Cyanosis
    • Treatment
      • PGE1
      • Restoration of acid/base balance
      • Surgical Evaluation
  • 11. Newborn Problems - Cyanosis
    • PGE1
      • 0.1 mcg/kg/min
      • Any intravenous site
        • UAC
        • UVC
        • Peripheral
      • Interosseous
  • 12. Newborn Problems Low Cardiac Output
      • Shock
      • Metabolic acidosis
      • Circulatory shutdown
  • 13. Newborn Problems Low Cardiac Output
    • Evaluation
      • Chest x-ray
      • Arterial blood gasses
      • Echocardiogram
      • Electrocardiogram
  • 14. Newborn Problems Low Cardiac Output
    • Left Sided Obstructive lesions
      • Hypoplastic left heart
      • Critical aortic stenosis
      • Critical coarctation of the aorta
  • 15. Hypoplastic Left Heart
  • 16. Severe Coarctation
  • 17. Newborn Problems Low Cardiac Output
    • Muscle diseases
      • Myocarditis
      • Cardiomyopathies
      • Sepsis
      • Asphyxia
  • 18. Newborn Problems Low Cardiac Output
    • Heart Rate Problems
      • Supraventricular tachycardias
      • Complete heart block
  • 19. Newborn Problems Low Cardiac Output
    • Supraventricular Tachycardia
      • Narrow Complex
      • Heart Rate > 220 bpm
      • Usually > 240 bpm
  • 20. Narrow Complex Tachycardia
  • 21. Newborn Problems Low Cardiac Output
    • Complete Heart Block
      • Heart rate below 60 bpm
      • No relationship between P waves and QRS’s
  • 22. Complete Heart Block
  • 23. Newborn Problems
    • Treatment
      • Left heart obstructive lesions
      • Muscle diseases
      • Heart rate problems
      • PGE1
      • Inotropic support and afterload reduction
      • Slow down or speed up
  • 24. Infant and Childhood Problems
    • Hypercyanotic spells
    • Congestive heart failure
    • Arrhythmias
  • 25. Infant and Childhood Problems
    • Hypercyanotic Spells
      • Tetralogy of Fallot
      • Pulmonary Atresia
  • 26. Tetralogy of Fallot
  • 27. Infant and Childhood Problems
    • Hypercyanotic Spells
      • Sudden decrease in pulmonary blood flow, usually in the morning
      • Provocation
  • 28. Hypercyanotic Spells
    • Treatment
      • Calming
      • Oxygen
      • Morphine
      • Beta Blocker
      • Phenylepherine
  • 29. Hypercyanotic Spells
    • Phenylepherine
      • Increase systemic vascular resistance which leads to less R - > L shunting and improved saturation
  • 30. Hypercyanotic Spells
    • Long Term Treatment with Propranolol
      • Indication for surgery, either palliative shunt or total repair
  • 31. Congestive Heart Failure
    • Differing etiology at different ages
  • 32. Congestive Heart Failure
    • Presentation in Infancy
      • Structural Diseases: Left Heart Obstructions
        • First days: Hypoplastic Left Heart Syndrome
            • Critical aortic stenosis
        • First month: Coarctation of the aorta
        • First 2 months: Left-to-right Shunts
          • VSD, PDA, Truncus Arteriosus
  • 33. Congestive Heart Failure
    • Presentation after infancy
      • Progression of structural heart disease
      • Arrhythmias
      • Infectious diseases
      • Later onset myopathies
      • Toxins:
        • Anthracyclines
        • Diphtheria
  • 34. Congestive Heart Failure Pre-load Afterload Contractility Heart Rate Determinants of Cardiac Output
  • 35. Congestive Heart Failure
    • Preload reduction
      • Diuretics
      • Fluid Restriction
      • High caloric density
  • 36. Congestive Heart Failure
    • Afterload reduction
      • ACE inhibitors
      • Nitroprusside
  • 37. Congestive Heart Failure
    • Heart Rate modification
      • Beta Blockers
        • Also treats diastolic dysfunction
  • 38. Contractility
    • Acute Treatment
      • Beta Agonists
        • Dobutamine
          • Afterload reduction also
        • Epinepherine
      • Dopamine
      • Increased myocardial demands
      • Milrinone
  • 39. Contractility
    • Milrinone increases contractility and reduces afterload without increasing myocardial oxygen demand
  • 40. Contractility
    • Chronic Treatment
      • Digoxin
      • New Treatments
  • 41. Arrhythmias
    • Narrow Complex Tachycardias
  • 42. Arrhythmias
    • Supraventricular Tachycardia
  • 43. Arrhythmias
    • Re-entrant Tachycardias
      • AV node re-entry
      • Wolfe-Parkinson-White
  • 44. Wolfe-Parkinson White
  • 45. Arrhythmias
    • Treatment
      • Pre-hospitalization
        • Diving reflex
          • Ice Bag to the face
        • Valsalva
        • Carotid Massage
  • 46. Arrhythmias
    • Hospitalization
      • Adenosine
        • Diagnostic and therapeutic
  • 47. Arrhythmias
    • Adenosine
      • 100 mcg/kg IV rapid push
      • Repeat every 5 minutes with increasing doses
  • 48. Arrhythmias
    • Shock requires Shock
      • Synchronized cardioversion
      • 1 joule/kg
  • 49. Arrhythmias
    • If adenosine fails:
      • Calcium Channel blockers
        • Not in infants!
  • 50. Arrhythmias
    • Digoxin Loading
    • Procainamide loading
    • Repeat adenosine
  • 51. Ventricular Tachycardia Image 3
  • 52. Wide Complex Tachycardias
    • Treat all as if Ventricular Tachycardia
  • 53. Wide Complex Tachycardias
    • Unstable rhythm requires Cardioversion 2 joules/kg
  • 54. Ventricular Fibrillation Image 4
  • 55. Wide Complex Tachycardias
    • Medical therapy
      • Lidocaine
      • Amiodarone
  • 56. Wide Complex Tachycardias
    • Surgical Therapy
      • Automatic Implantable Cardioverter-Defibrillator