Common precipitation events:
- Tachycardia (decreased filling time leads to reduced end diastolic volume)
- Medications (ACE inhibitors)
Treatment: Sequentially, it should be followed as mentioned below:-
- First and foremost: no need to hurry for oxygen as it does not help much in spells.
- Knee-chest position
- Morphine subcutaneously: will calm the child
- Fluid boluses
- Oxygen: preferably by nasal prongs as face mask can increase irritability of the child
- Ketamine: will calm the child as well as increase Systemic Vascular Resistance (SVR) and will lead to increase blood flow to the lungs
- Propranolol / Esmolol: thought to decrease infundibular obstruction; decreases tachycardia leading to greater diastolic filling
- Phenylephrine: Increase SVR; generally used as last line medication
- Bicarbonate: to correct any metabolic acidosis, if present.