CHD Things
Unit Policies/ Procedures
X RAYS
Vent/ ABGs
Arrythmias And Treatments
100

What is a big concern (hemodynamically) for patient's s/p repair of coarctation of the aorta?

Why is this a big concern to the physicians? 

Paradoxical HTN

LV is used to having to use lots of force to adequately provide for the body through the coractation- when repaired, the LV has to "re-learn" that it doesn't need as much force. Thus can cause HTN. Will self correct over time. 

Can pop sutures/ tamponade! 

100
How do you TPA a occluded port? 

Pre-measure TPA volume for your line! 

Stopcock with TPA> pull back on empty syringe and rotate stopcock while aspirating, line should pull in TPA

100

What do you see in this xray? 


Pleural effusion 

100

How can you tell if your ETT is in the correct spot without touching the patient? 

ETCO2

TV 

SPO2 

100


SVT

Vagal Manuvers

Adenosine 

Synchronized Cardioversion 

200

Your patient is a post op day 4 VSD repair. 4 month old. Intubated.

Your patient alarms. These are the vitals- what is your course of action. 

HR 60, BP 60/30, SPO2 70, ETCO2 60

Yell for help/ push staff assist. 


Support ventilation first! Bag or manual breaths. Provide supp fio2. 

What do you think happened to this patient? 

200

Your patient is 3 months old, has a PIV, a single lumen power PICC and a g tube.

Does your patient get a CHG bath? What about this patient indicates that they get a chg? 

Yes!

Central Line

Older than 2 month! 

200

What is wrong with this Xray? 


ETT is right mainstem 

ETT should be between 2nd and 4th intercostal space

200

VBG on 2 Ventricle Patient - SpO2 95

Oxyhbg- 45

AVO2 difference is 50 (Norm 20-40) 

High is indication of high consumption of O2. Can be indication of low cardiac output.

Causes of low SVO2- low hgb (less carrying capacity), SaO2 is low. 

Treatment- supportive and treat cause if treatable. 

200


Junctional 

Symptomatic or Asymptomatic 

Sedation

Electrolytes (Magnesium!)

Keep Cool 36-37 

Override pace if wires are present 

Meds: Precedex, Amiodarone (Give CaCl prior), procanamide, esmolol 

300

What is the flow of blood through the heart of a hlhs patient s/p hybrid?

IVC/ SVC > RA> RV & LA (Through asd)> PA's > lungs & through PDA to body 

300

It is a Tuesday. Your patient has a right IJ TL. 

Upon initial assessment, the TL dressing is peeling up and the port is exposed partially. 

Does this dressing need to be changed? 

Change the dressing

Dressing are Q 7 days, on Sundays ideally 

BUT CHANGE if not occlusive. 

If still occlusive but starting to peel you may secure with additional dressing. 

300


NG tube is in lungs

300

How can you adjust a patient's CO2 on a ventilated patient?

Goal

Lower CO2- increase the rate OR increase the TV (on volume control you can choose a tv) on pressure control you can provide additional support/ pressure 

Raise CO2- wean rate/ sedate patient breathing over rate, decrease pressure/ TV

300


V Tach

Runs vs Sustained? 

CPR/ Defibrillate

Amio or Lidocaine 

Electrolyte replacement if stable? 


400

What are the 3 (or 4) stages of repair of a hypoplastic LH patient? 

Hybrid

Norwood

Glenn

Fontan 

400

How often should caps/ microclaves at the end of a central line be changed? 

every 4 days! same as the tubing! 

400


Pneumothorax L Side

Pneumos have no lung markings, only air which appears dark on xray. 

400

Interpret this ABG

7.56/26/70/30/-1

Ventilated patient. What is your intervention? 

Respiratory alkalosis

Patient is being over-ventilated

Wean rate/ give sedation. 

400

HR = 190 

Sinus Tachycardia

Treat cause!

Causes: Irritability, hypovolemia, hyperthermia, sepsis, heart failure, hypoxia

Tamponade? 

500

Why can't a single Ventricle (mixer) patient cry for a long time?

"Cry or die" physiology

500

How often do we change our arterial line dressings? 

As needed! 

500

What congenital heart defect has this boot shaped xray? Why? 

Tetralogy of fallot - RV hypertrophy! 

500

How would you interpret this gas? What treatment would you expect for a gas like this? What probably caused it? 

7.53/40/80/38/+9


Metabolic Alkalosis

What treatment? Diamox or wean diuretics

Cause: Lasix/ hypovolemia 

500

HR 80 

Patient 5m 

Sinus Bradycardia 

Pacing if wires present! 

Epinephrine or Atropine if symptomatic 

Treat underlying cause- did patient vagal? Hypothermia?