PED TUTORIAL

PRESENTERS:
Paul Mulenga-5th YR
Chimika Phiri-7th YR
MODERATOR:
PROF Chintu
TOPIC:
Cyanotic CHD
 PERSONAL DETAILS
• NAME;LB Male
• AGE;2 yr 8mo
• ADRESS;Kawambwa
• REL;CMML
Informant was the father.Pt referred from Arthur
Davison hosp for further Mx of CHD

ON ADMISSION
Hx of bluish discoloration of body 2 4/12
 Hx OF SYMPTOM
• Started when the child was 4/12.However was
described as relatively well prior to this.
• The color change was first noticed on the
toungue,lips and later the palms ,fingers & toes
were involved
• The symptom was worsened by warm
baths,cough & fever.No H/o rigors ,convulsions
or headache
• Accompanied by laboured breathing
 HX Cont…
• These episodes would last for not more
than 2 days after which would disappear
on there own.Recurrence after 3-4 days
• Hx of fainting once.Tx for ashma & TB.No
improvement.Condition worsend.
• Increased tendancy to squat following mild
exertion
• Dx of CHD made at Arthur Davison on
Echo
 Hx cont…
• No hx of :edema,RUQpain,orthopnea
chest pains,night sweats
 SYSTEMIC REVIEW
GIT;No Hx of dysphagia,apetite normal.
Vomiting,abd distention,diarrhoea,bowel
motions normal,wt loss*
GUS;No Hx of dysuria,hematuria,vol &
colour normal
MSS;No Hx of Jt pains/swellings,no skin
rashes
 PAST MED Hx
• Had several episodes of similar illness

• 3rd hospital admission, admitted 3X at

clinic

• Hx of scabies at 3/12,Tx successfully

• No hx of measles,diarrhoea,sore throat
 DRUG Hx
• Salbutamol ,aminophyline ,ATT at clinic
• Lasix,Slow K,Procaine penicillin at hosp
• Currently on Xpen & Gentamicine
• Hx of herbal medication

BIRTH Hx
Born on 23/03/04 at clinic by SVD at term Bwt
2Kg
Antenatally health good but had scabies prior to
delivery.A/S good.RVD non reactive
 DEVELOPMENTAL Hx
• ? Social smile & neck control
• Sit without support 6 mo (7mo)
• Crawl 8 mo (8-10)
• Stand without support 9 mo (9 mo)
• Growth relative to other chn described as
delayed
 NUTRITIONAL Hx
• Started B/F within 24 hrs of birth
• Supplements at 6/12
• Stopped B/F at 2 yrs
• Semi & completely solid food

IMMUNIZATION Hx
Fully immunized(U5C* & BCG scar)
 FAMILY Hx
• 4th born in family of 5
• No hx of ped deaths
• No hx of CHD,HTN,DM,Epilepsy or TB

SOCIAL/ECON Hx
Father & mother are peasant farmers.Income
adquate,both went up to primary level of
education.Live in a hut,use well & pit latrine
 SUMMARY
• Hx of a 2 8/12 male known CHD pt who
presented with a 2 4/12 hx of recurrent episodes
of dark blueish colouration of the body affecting
mostly toungue,lips,fingers & toes-Triggered by
warm baths,fever cough &
exertion.Accompanied by dyspnoea
• Hx of fainting,easy fatiguability & tendency to
squat following exertion.
• No hx of pedal edema or RUQ pain
 IMPRESSION
• Cyanotic CHD
Tetralogy of fallot
Fallots physiology
Pentalogy of Fallot
 EXAMINATION
Examined a male child sitting comfortably
in bed with O2 nasal cetheter.Was fully
conscious,awere of his surroundings.Was
in resp distress,No neck vein distention
Afebrile ,P cyanosis+,J* Finger club G4
OC:dental caries,C cyanosis,PE*,LN*
VITALS
RR;60/min Pulse;86/min Temp;36.5
 EXAM cont…
ANTHROPOMETRY
HC;47cm MUAC;13 cm LENGTH;76cm
Wt;8.7Kg
CVS
Precordium HA*,Apex ?5-6 ICS MCL Lt
Thrill*,S1S2 heard,systolic mumurs
 RESP
Chest symmetrical,moving with resp
trachea central,normal vesicular sounds,no
 added sounds
ABDOMEN
Symmetrical,not distended moving with
resp.
Non tender,R tenderness*
S+(4cmBCM) L+(2cmBCM),K*
Bowel sounds +
 SUMMARY
Examined a male child sitting confortably
in bed with O2 nasal cetheter.Was
inRD,afebrile,
both peripherally & centrally cyanosed with
G4 finger clubbing.Chest exam reveald no
mummurs although there was
hepatosplenomegaly(2+4cm)
 IMPRESSION
• CHD
Tetralogy of Fallot
Fallots physiollogy
• Septicemia
 MANEGEMENT
 INVESTIGATIONS
• FBC
• CXR
• ECG
• ECHO

 PRINCIPLES OF Mx
• Mx of hypercyanotic spells
• Correction of dehydration & anaemia
• Rx of infections

 Mx OF HYPERCYANOTIC SPELLS
• Confort the child & place in knee-chest
 Mx cont…
• Administer humidified oxygen by face mask
• Give morphine (0.1-0.2 mg/Kg IV)
• If dehydrated, give IVF & vol expansion
• If anemic, give blood
• Tx acidosis with sodium carbonate
• Administer propranolol (0.1-0.2 mg/Kg IV/PO)
• Vasopressors e.g methoxamine & phenylephrine
 Mx cont…
SURGERY
• Palliative
Modified Blalock-Taussig operation
Potts operation
Waterson operation
TOTAL SURGICAL OPERATION
COUNSELLING
PROGNOSIS