Professional Documents
Culture Documents
Problems in Pediatrics
Case 1
A seven-year-old boy presents with dyspnea,
tachypnea for 1 day. He has had upper
respiratory tract infection for 2-3 days with
rhinorrhea, low grade fever.
PE: T 36.5oC, RR 40/min, HR 140/min, BP 80/60,
dyspnea, capillary refilled 5 second,
restlessness
Lung: fine crepitation,
CVS: Normal S1,S2, S3 gallop, soft SM grade 2/6
at apex
Liver: 3 cm below RCM, rubbery consistency
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Cardiogenic shock
Cardiogenic shock
Physiology :
CO = HR X SV
SV = EDV X (EDV-ESV)
EDV
CO = HR X EDV X EF
Oxygen delivery = CO x Hb X SaO2 x 13.9
Clinical manifestations
Low cardiac output
• Grayish color
• Poor peripheral perfusion
• Hypotension
• Conscious change
• Urine output decrease<0.5-1 ml/kg/hr.
• Metabolic acidosis
• Decrease oxygen saturation in venous
blood gas
• Increase serum lactate
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Signs and symptoms of low cardiac outputs
Cardiogenic shock
Etiology
2. Myocardial diseases:
myocarditis, cardiomyopathy
3. Cardiac dysrhythmia
4. Cardiac tamponade
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aPVR , pulmonary vascular resistance; SVR, systemic vascular resistance; and PDE3, phosphodiesterase inhibitor.
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Case 2
A one-year-old boy with history of cyanotic
heart disease presents with deep cyanosis
after crying for 15 min.
He develops dyspnea and unconscious
PE: RR 30/min, PR 120/min, BP 80/65, deep
cyanosis, O2 sat 40-50%,
Heart: normal S1, S2, SM grade 1/6 LUSB
Lung: clear
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Hypoxic spell
PA AO
PVR SVR
RV LV
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Pathophysiology of hypoxic spell
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Hypoxic spell
Hypoxic spell
Continue management
Propanolol IV: 0.1 mg/kg/dose dilute IV slowly
(monitor HR)
Correct hypoglycemia: 25% glucose 1-2
cc/kg/dose IV push
Keep normal systemic BP
Correct Hct: PRC infusion (anemia), blood
letting (polycythemia; Hct >65%)
Paralyze and ventilate
Emergency shunt surgery
Closed FU. blood gas, correct acidosis etc.
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Case 3
Cardiac Dysrrhythmia
Management of SVT
Physiological treament:
Vagal maneuver - Ice pack
Gag reflex - Carotid massage
Medical treatment
Adenosine: 0.1-0.3 mg/kg/dose: 2 syringe
technique, max 12 mg
Propanolol: 0.1 mg/kg/dose, dilute, IV slowly
Verapamil: 0.1 mg/kg/dose, dilute, IV slowly
Amiodarone: 5-10 mg/kg IV drip in 1-2 hrs.
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Management of SVT
Electrical treament
Direct current synchronous mode
0.5-2 J/kg, max 4 J/kg
Overdrive pacing
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Electrical Cardioversion
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Tachyarrhythmia
Ventricular tachycardia
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Polymorphic VT
Management of VT
Mechanical: resuscitation
Electrical treatment: DC shock or
synchronized mode 2-4 J/kg
Medical:
Lidocaine:1 mg/kg IV bolus, follow by IV
infusion
Amiodarone: 5 mg/kg IV in 20-60 min , follow
by IV infusion
Procainamide 15 mg/kg IV drip in 30-60 mins
MgSO4: 25-50 mg/kg IV, max 2 gm
Correct hypoMg, hypoCa, hypo&hyperkalemia
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Cardiac dysrrhythmia
Bradyarrhythmia: abnormally slow heart and rhythm
complete heart block: congenital, acquired (post
operative CHD)
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Temporary pacemaker
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Case 4
Differential Diagnosis
Adapted J Pediatr. 1970;77:484; Peiatr Rev. 1982;4:13; and Arch Dis Chid. 1976;51:667.
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Management
Tachyarrhythmia
Cardiogenic shock
Congestive heart failure
Hypoxic spells
Cardiac arrhythmia:
Tachyarrhythmia
Bradyarrhythmia
Pulmonary hypertensive crisis
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