anoxic spell by asogwa innocent kingsley

12
ANOXIC SPELL PRESENTED BY : ASOGWA INNOCENT KINGSLEY ML508

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Page 1: Anoxic spell by asogwa innocent kingsley

ANOXIC SPELL

PRESENTED BY :ASOGWA INNOCENT KINGSLEY

ML508

Page 2: Anoxic spell by asogwa innocent kingsley

DEFINITION

Anoxic spells Anoxic spells (synonyms- hypoxic, (synonyms- hypoxic, hypercyanotic, blue, tet ) hypercyanotic, blue, tet ) – paroxysmal attack of – paroxysmal attack of dyspneadyspnea

Page 3: Anoxic spell by asogwa innocent kingsley

PREVALENCE� Occur predominantly after waking up or Occur predominantly after waking up or

following exertionfollowing exertion� Most commonly start around 4 to 6 Most commonly start around 4 to 6

months of agemonths of age� Frequency varies from once in a few Frequency varies from once in a few

days to numerous attacks every daydays to numerous attacks every day

Page 4: Anoxic spell by asogwa innocent kingsley

AETIOLOGY/PATHOGENESISMainly seen in patient with tetralogy of Mainly seen in patient with tetralogy of falotfalot� unpredictable episodes unpredictable episodes � The mechanism: spasm of the The mechanism: spasm of the infundibular septum, which acutely infundibular septum, which acutely worsens the RV outlet obstruction. worsens the RV outlet obstruction.

Page 5: Anoxic spell by asogwa innocent kingsley

COMPENSATORY MECHANISM

� Sitting posture – squattingSitting posture – squatting� Squatting increases the peripheral Squatting increases the peripheral

vascular resistance, vascular resistance, � which diminishes the which diminishes the

right-to-left shunt right-to-left shunt � increases pulmonaryincreases pulmonary

blood flow. blood flow.

Page 6: Anoxic spell by asogwa innocent kingsley
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CLINICAL FEATURES� Characterized byCharacterized by

1. Sudden crying1. Sudden crying

2. Sudden onset or deepening of cyanosis2. Sudden onset or deepening of cyanosis

3. Sudden onset of dyspnea3. Sudden onset of dyspnea

4. Alterations of consciousness4. Alterations of consciousness

5. Convulsions5. Convulsions

6.Decrease in intensity of systolic murmur6.Decrease in intensity of systolic murmur

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Page 9: Anoxic spell by asogwa innocent kingsley

DIAGNOSIS� AnamnesisAnamnesis� Physical examinationPhysical examination

� EchocardigraphyEchocardigraphy

Page 10: Anoxic spell by asogwa innocent kingsley

MANAGEMENT OF ANOXIC SPELL

1)1) Knee chest position

2) Humified O2

3) Be careful not to provoke the child 1) Especially you are bad at gaining IV access

2) Ask for help from someone more experience

3) Permit the baby to remain with mother

4) Morphine 0.1 -0.2 mg/Kg Subcutaneous

5) Correct acidosis – Sodium Bicarb IV

Page 11: Anoxic spell by asogwa innocent kingsley

MANAGEMENT OF ANOXIC SPELL

6) Propanolol1) 0.1mg/kg/IV during spells

2) 0.5 to 1.0 mg/kg/ 4-6hourly orally

7) Vasopressors: Methoxamine IM or IV drip

8) Correct anemia

Page 12: Anoxic spell by asogwa innocent kingsley

THANK YOU FOR YOUR ATTENTION