Patients with CHD are exceptionally sensitive to the effects of bronchiolitis on their volume status Four principles of treating a Tet Spell 1.Redirect blood flow to the lungs. In a Tet spell your aim is to redirect the blood from the left side of the heart to the right side of the heart to improve pulmonary blood flow by increasing afterload. You can achieve this with IV phenylephrine 5-20mcg/kg IV push q1-2 minutes (add 10mg of phenylephrine to a 1L bag of normal saline so that the concentration is 10mcg/ml). 2.Anxiolysis to improve work of breathing. Give IV morphine 0.05-0.1mg/kg. 3.Correct acidosis. Give IV sodium bicarbonate 1-2mEq/kg. 4.Avoid positive pressure ventilation when possible as it directs blood flow away from the right side of the heart where the Tet spell patient needs it most, even if the patient’s oxygen saturation is very low. #Management #Peds #Pediatrics #CHD #CongenitalHeartDisease #Bronchiolitis
