Classify every congenital lesion by whether pulmonary blood flow is increased, decreased or obstructed, and by whether it depends on the duct staying open. Click the defects on the map, run a critical CHD pulse oximetry screen, then rebuild a hypercyanotic spell in the order that actually breaks it.
Explore the circulation
Six defects sit on the map itself. The complex and cyanotic lesions are listed underneath, because they are combinations rather than single holes.
The screen is performed at 24 to 48 hours of age on the right hand and either foot. A failed screen requires echocardiography, not reassurance.
The spell
A 5-month-old with tetralogy of Fallot has been crying since a nappy change. She has become deeply cyanotic, is breathing hard and fast, and is growing limp in her father’s arms. Choose the actions in the order they should happen.
Pick a lesionClassify by pulmonary blood flow and obstruction
Waiting
Click a defect on the map, or choose one from the list.
Central cyanosis becomes visible when roughly 5 g/dL of haemoglobin is desaturated — so a polycythaemic child looks blue earlier, and an anaemic child can be dangerously hypoxaemic while still looking pink.