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A 3-year-old boy with repaired tetralogy of Fallot (RVOT patch + transannular patch) is admitted to the cardiac ICU with worsening fatigue and presyncope. He is postoperative day 5 following pulmonary valve replacement. He suddenly develops a regular wide-complex tachycardia at 220/min, with MAP decreasing to 45 mmHg despite fluid bolus. Near-infrared spectroscopy demonstrates declining … Read more
A 6-year-old child on postoperative day 2 after atrial septal defect repair develops sudden tachycardia with a heart rate of 160–170/min. Blood pressure is stable but trending downward. The monitor shows a regular narrow-complex tachycardia. The child is irritable with mild hepatomegaly and rising lactate. Adenosine transiently slows the ventricular rate, but the tachycardia immediately … Read more
A 4-year-old child with severe pneumonia is mechanically ventilated for hypoxemic respiratory failure. On day 3, oxygen requirement increases (FiO₂ 0.75), PEEP is 8 cmH₂O, and plateau pressures are rising. The child develops tachycardia, increasing ventilator asynchrony, and decreased right-sided breath sounds. Bedside lung ultrasound is performed. The image above is obtained from the right … Read more
A 2-day-old term neonate, birth weight 3.2 kg, is admitted urgently to the Pediatric Cardiac ICU for profound cyanosis noted shortly after birth. Pregnancy and delivery were uncomplicated, and Apgar scores were reassuring. However, within hours, the infant developed persistent hypoxemia with oxygen saturations in the 60s despite 100% oxygen.The infant is tachypneic but not … Read more
A 3-month-old infant, weight 4.5 kg, is admitted to the Pediatric Cardiac ICU from the emergency department for worsening cyanosis and episodic desaturations, particularly during agitation and feeding. The infant was born at term, has had poor weight gain, and has not undergone prior cardiac surgery.On arrival to the ICU, the child is tachypneic with … Read more
Identify the machine. Answer: It is an ECMO machine, which is used to support the heart and lungs depending on the condition. Pediatric ECMO Case-Based Summary and Complete Management Walkthrough Case Stem (Initial Presentation) A 4-year-old boy, weight 16 kg, previously healthy, presents to the ED with: ⦁ 5 days of fever ⦁ Cough and … Read more
An 8-year-old child is on postoperative day four following repair of Tetralogy of Fallot. He has been recovering well in the PICU until the recent onset of labored breathing and decreased breath sounds on the right side. The chest drain was removed yesterday. His oxygen requirement has risen from room air to high-flow nasal cannula … Read more
