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Pediatric Cardiovascular Emergency
Approach and initial management of PCE for pediatricianDr Hamid
MohammadiPediatric Cardiologist
Shiraz University of Medical sciences Pediatric WardNov
2016Thanks for Dr Shahraban Abdulla ;Consultant Pediatric
Cardiologist; Latifa Hospital, DHA for sharing his presentation in
this field
What we earn with this presentation Lecture
structureCardiovascular emergency among pediatric emergency
department Introduction
What we should doneManagement
Guide to correct diagnosisClue for DDX
Sign and SymptomCommon Cause
What is the presenting scenarioPresentation
IntroductionCardiac emergencies are among the most stressful ED
presentations.Cardiac Problem in infancy & childhood are not
rare, often are complex.Cardiac disease in infancy & childhood
can be congenital or acquired.2nd or 3rd cause of emergency
mortality department
PCE - Common Causes
Ductal Dependent CHD with PDA dependency
Scenario oneA 5 days old neonate with cyanosis and irritability
since last night
She is product of NVD with no significant prenatal and delivery
time historyNow she is tachypnic and has respiratory distress
Ductal dependent lesion- Causes
Ductal dependent lesion- Presentation
Ductal dependent lesion- Management
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Hyper cyanotic AttackTOF physiology is the major cause of this
attackMay be result of non cardiac sourcePresentation:Period of
uncontrollable crying / panicRapid and deep breathing (hyperpnoea)-
Clear lungDeepening of cyanosisheart murmurLimpness, convulsions
Rarely, death. Common in Early morning
Spell Physiology and TxTreatment strategy: SVRKnee chest
positionPhenylephrineDecrease anxiety:Hugging BabyMorphineO2
therapyHydrationTreatment of AcidosisInderal (0.01mg/kg Iv
slowly)Sedation and IntubationKetamine ( SVR)
Decompensated HeartThe end stage of Cardiac disease
Scenario TwoA 6 month old infant with nausea, vomiting and
malaise since 2 weeks ago. Since 2 days ago patient had sporadic
cough and also poor feeding
Negative family history of any cardiac disease in
childhoodPatient has grunting and R/D Abdominal exam reveled
Hepatomegaly
Decompensated Heart - Causes
Decompensated Heart Common PresentationDifferent causes lead to
similar sign and symptom in the end stage Typical CHF
presentationDiagnostic Clue for HF:Gallop Rhythm Hepatomegaly (Rt
side failure)Poor filling pressure (More with Lt side failure)Cold
extremity (More with Lt side failure)Rales (Lt side Failure)
Decompensated Heart Specific Presentation
Decompensated Heart failure- Management
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ArryhtmiaWhen your art and knowledge are everythings
Scenario Three
Emergency DysrhythmiaCauses and Presentation
Emergency Dysrhythmia - Management
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TamponadDiagnosis is critical for early intervention
Scenario Four
Tamponade- Causes
Tamponade - PresentationBeckes triad is not usual in pediatric
and is late finding ( Muffled Heart sound, Engorge Neck vein ,
Hypotension)Pulsus paradoxusKussmaul's signNon specific symptomNeed
high index of suspicion to detectNeed Echocardiographic assessment
for early intervention
Tamponade - Presentation
Decompensated Heart failure- Management
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PointsHistory and Physical exam is the most informative data to
select the best management in pediatric Cardiovascular emergency
(PCE)Most of Cardiovascular emergency could be managed without
echocardiography in initial visitIv fluid handling, Diuretic and
inotrope support are the 3 basis of treatment in the PCE
Research proposal
Dr Hamid MohammadiThank you