Hypovolemia
If bleeding 25% of infant is catastrophic. Normal blood vol is 75-80ml/kg
Cardiogenic shock
Left ventricular disfunction. Diastolic failure, Sys failure, apical ballooning, myocarditis
Obstructive shock
Heart tamponade (Becks triad ) pulm embolism, tension pnuemo ❤️ LVoT, Tricuspid atresia, HLHS
Distributive shock
Container failure capillary leak issues. Sepsis, anaphylaxis, meurogenic
The 3 H’s
Hypoxia, hypovolemia, Hypotension,
Pericarditis
Viral or bacterial. Sharp.chest pain that radiates up neck. Worse when laying down
NRP sat goals @ birth
Minutes of age. Sats
1. 60-65%
2. 65-70%
3. 70-75%
4. 75-80%
5. 80-85%
10. 85-90%
Neo fluid management
If < 28wk 100ml/kg/day
If >28wk or term 60-80
Fluid management for pedi
4ml/kg for 1st 10kg
2ml/kg for 2nd 10kg
1ml/kg after that
Cyanotic Right to left shunts
Needs PGE
Sats 75-80
Acyanotic heart
Ventricular inflow or outflow obstruction
Causes blood to back up into lungs= CHF.
Left to right shunt causes Hypoxia & PHTN
Trunkus arteriosus
Pulmonary artery fuses w aorta has a large VSD
tx- PGE @ .03-.1mcg/kg/min to keep PDA open
Rashkund procedure (make an ASD )
Surgery to separate PA from aorta and make conduit from RV to pa. Close VSD then close PDA w acetaminophen
TGA
Baby has severe Hypoxia
At risk for air emboli.
PGA
Tx- rashkund procedure, Jantene procedure (arterial switch plus coronary switch. Tylenol pda
Tricuspid Atresia
No valve, small R vertical. ASD & vsd present.
BT shunt in 1 week.
Glen shunt@ 4-6 weeks(svc cut and attached to Pulm art)
Fontana @ 2-3yo (direct IVC and connect to bottom of Pulm artery w pop-off to RA
TOF
VSD
OVERIDING AORTA
STENOTIC PULM.VALVE
RV HYPERTROPHY
HYPERTROPHIC- MYOCARDOPaTHY
Hypoxic all the time.
Tet spells
Tx- close holes, dilate Pulm valve
TAPVR
Pulm veins via an anomalous vein empty into RA, IVC, or other vein returning to heart
Tx PGA for PDa make ASD, connect to LA
Coarctation
Not diagnosed when first born, can be days later when PDA closes.
4 point BP
Need PGA
VSD
Most common heart defect
HLHS
Pge,
Sats 70-80%
Keep fio2 at 21% d/t high o2 dilates Pulm art and blood floods lung and body doesn’t get blood
Tx- 3 step surgery:
Norwood Procedure=
1.Pulm art connect to aorta in 1st week of life.
2.@ 4-6mo Glenn procedure( direct svc & attach to Pulm art)
3. @ 2-3 yo Fontan= IVC to Pulm art w conduit to RA
CYANOTIC ❤️
COARC
HLHS
TOF
TOGV
❤️ deviation
newborns are born w Right axis deviation.
If newborn w/in first few days of life has a left axis deviation= left ventricular hypertrophy
