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<< Congenital Heart Disease In Pediatric Patients: Recognizing The Undiagnosed And Managing Complications In The Emergency Department

Emergency Department Evaluation

Initial Evaluation And Stabilization

The evaluation of the pediatric patient with suspected or known CHD follows the usual ED approach of prioritizing airway, breathing, and circulation. Airway emergencies in this population may be related to associated anatomic abnormalities in children with certain syndromes (such as macroglossia in children with Down syndrome) and CHD. (See Table 3.) Breathing is assessed by noting both the respiratory rate and work of breathing (subcostal, intercostal, suprasternal retractions, nasal flaring, grunting) as well as color, pulse oximetry, and mental status. Irritability may be a sign of hypoxemia, while lethargy may indicate hypercapnia or inadequate perfusion/shock. “Quiet tachypnea” (increased respiratory rate without significant work of breathing) may be noted in neonates with poor systemic or pulmonary perfusion (eg, CoA with a closing ductus arteriosus or TOF with significant pulmonary stenosis). 

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Last Modified: 11/17/2017
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