2. “The patient is greater than 1 week old, so the diagnosis cannot be a ductal-dependent CHD. The DA should have closed days ago.” Patients with ductal-dependent cardiac disease, especially ductal-dependent systemic blood flow, may have persistence of DA patency beyond 24 hours of life as a result of increased DA blood flow. Cardiovascular collapse in a child less than 1 month of age should be considered as a CHD with ductal-dependent systemic blood flow until proven otherwise.
3. “The infant is febrile. We should evaluate and treat for sepsis. CHD is not likely.” While sepsis is more common and should be suspected in any neonate presenting to the emergency department with tachypnea, cyanosis, or shock, a diagnosis of CHD should not be excluded based solely on the presence of fever. In fact, the presentation of a patient with CHD may be precipitated by an infectious process.
4. “The blood pressure and SpO2 obtained in triage are normal. I’m reassured.” Infants presenting to the emergency room in distress should have blood pressure and SpO2 measurements performed on the right upper extremity and one lower extremity. A discrepancy between the two extremities is suggestive of CHD.
July 14, 2008 at 11:35 am |
Few clinicians realize that conventional blood pressure cuff bladders have off-centered tubes that are typically right or left arm specific. Unless properly placed, pressure may be exerted on the bone instead of on the artery which can lead to inaccurate readings.
A Balanced Bladder design has centered tubes, is longer, and more fully encircles the arm as recommended by the American Society of Hypertension and the American Heart Association. This design facilitates accurate blood pressure readings on both right and left arms and helps practitioners achieve optimal arterial compression.