Cyanotic Spell

Common precipitation events:

1. Crying
2. Defecation
3. Fevers
4. Dehydration
5. Tachycardia (decreased filling time leads to reduced end diastolic volume)
6. Medications (ACE inhibitors)

Treatment: Sequentially, it should be followed as mentioned below:-

1. First and foremost: no need to hurry for oxygen as it does not help much in spells.
2. Knee-chest position
3. Morphine subcutaneously: will calm the child
4. Fluid boluses
5. Oxygen: preferably by nasal prongs as face mask can increase irritability of the child
6. Ketamine: will calm the child as well as increase Systemic Vascular Resistance (SVR) and will lead to increase blood flow to the lungs
7. Propranolol / Esmolol: thought to decrease infundibular obstruction; decreases tachycardia leading to greater diastolic filling
8. Phenylephrine: Increase SVR; generally used as last line medication
9. Bicarbonate: to correct any metabolic acidosis, if present.