Pediatric Cardiovascular emergency
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Transcript of Pediatric Cardiovascular emergency
Slide 1
Pediatric Cardiovascular Emergency
Approach and initial management of PCE for pediatricianDr Hamid MohammadiPediatric Cardiologist
Shiraz University of Medical sciences Pediatric WardNov 2016Thanks for Dr Shahraban Abdulla ;Consultant Pediatric Cardiologist; Latifa Hospital, DHA for sharing his presentation in this field
What we earn with this presentation Lecture structureCardiovascular emergency among pediatric emergency department Introduction
What we should doneManagement
Guide to correct diagnosisClue for DDX
Sign and SymptomCommon Cause
What is the presenting scenarioPresentation
IntroductionCardiac emergencies are among the most stressful ED presentations.Cardiac Problem in infancy & childhood are not rare, often are complex.Cardiac disease in infancy & childhood can be congenital or acquired.2nd or 3rd cause of emergency mortality department
PCE - Common Causes
Ductal Dependent CHD with PDA dependency
Scenario oneA 5 days old neonate with cyanosis and irritability since last night
She is product of NVD with no significant prenatal and delivery time historyNow she is tachypnic and has respiratory distress
Ductal dependent lesion- Causes
Ductal dependent lesion- Presentation
Ductal dependent lesion- Management
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Hyper cyanotic AttackTOF physiology is the major cause of this attackMay be result of non cardiac sourcePresentation:Period of uncontrollable crying / panicRapid and deep breathing (hyperpnoea)- Clear lungDeepening of cyanosisheart murmurLimpness, convulsions Rarely, death. Common in Early morning
Spell Physiology and TxTreatment strategy: SVRKnee chest positionPhenylephrineDecrease anxiety:Hugging BabyMorphineO2 therapyHydrationTreatment of AcidosisInderal (0.01mg/kg Iv slowly)Sedation and IntubationKetamine ( SVR)
Decompensated HeartThe end stage of Cardiac disease
Scenario TwoA 6 month old infant with nausea, vomiting and malaise since 2 weeks ago. Since 2 days ago patient had sporadic cough and also poor feeding
Negative family history of any cardiac disease in childhoodPatient has grunting and R/D Abdominal exam reveled Hepatomegaly
Decompensated Heart - Causes
Decompensated Heart Common PresentationDifferent causes lead to similar sign and symptom in the end stage Typical CHF presentationDiagnostic Clue for HF:Gallop Rhythm Hepatomegaly (Rt side failure)Poor filling pressure (More with Lt side failure)Cold extremity (More with Lt side failure)Rales (Lt side Failure)
Decompensated Heart Specific Presentation
Decompensated Heart failure- Management
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ArryhtmiaWhen your art and knowledge are everythings
Scenario Three
Emergency DysrhythmiaCauses and Presentation
Emergency Dysrhythmia - Management
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TamponadDiagnosis is critical for early intervention
Scenario Four
Tamponade- Causes
Tamponade - PresentationBeckes triad is not usual in pediatric and is late finding ( Muffled Heart sound, Engorge Neck vein , Hypotension)Pulsus paradoxusKussmaul's signNon specific symptomNeed high index of suspicion to detectNeed Echocardiographic assessment for early intervention
Tamponade - Presentation
Decompensated Heart failure- Management
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PointsHistory and Physical exam is the most informative data to select the best management in pediatric Cardiovascular emergency (PCE)Most of Cardiovascular emergency could be managed without echocardiography in initial visitIv fluid handling, Diuretic and inotrope support are the 3 basis of treatment in the PCE
Research proposal
Dr Hamid MohammadiThank you