A mother brings her 2 year old son to the ED. She claims his skin color appears dark intermittently and he is often short of breath. He was born in Central America and has had no medical follow up. Recently she was told that the child had a congenital heart problem. When you start to examine the child he starts to cry and immediately turns blue. The mother places him in the position shown. If this maneuver fails to relieve his symptoms, what else can you attempt?
A. Hold him upside down by his legs
B. Administer bronchodilator therapy
C. Perform a Heimlich maneuver
D. Administer morphine
E. Administer subcutaneous epinephrine
F. Place him in Trendelenburg position
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The child most likely has tetralogy of fallot. Common Cyanotic precipitation events include Crying, Defecation, Feeding, Awakening from naps, Fever, and Dehydration
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Tachycardia (decreased filling time leads to reduced end diastolic volume) and use of medications (ACE inhibitors) that decrease afterload can precipitate cyanosis
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The Knee-Chest Position increases Preload and increases SVR and instantly relieves cyanosis
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Morphine is a great drug as it calms the child, decreases tachypnea, and also decreases PVR.
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AVOID Epinephrine and Isoproterenol – as these will decrease SVR and worsen the cyanosis. An increase in afterload pushes more blood towards the lungs and vice versa.