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.

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