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Cyanotic congenital HEART disease? STEP-by-STEP work up
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- Опубліковано 2 жов 2022
- Introduction to CARDIAC disease- PART I.
What is cyanosis? What is differential cyanosis? What tests should you order? What is the CCHD screen? What is the hyperoxia test? What about X-Rays? What is a boot-shaped heart anyway?!!! When do you start PGE? Learn ALL THIS and more in this introductory video.
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Please be sure to give us a like, comment about future topics, and subscribe to this channel to stay up to date on all things NICU! Also, click the notification bell after you subscribe to gain your weekly NICU knowledge as soon as it's loaded!
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Dr. Tala is a board-certified neonatologist and has worked in busy level III and IV units for the past 15 years. She has won multiple teaching awards throughout her time as a neonatologist.
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**TIMESTAMPS**
01:22 Cyanosis
04:07 Acrocyanosis
05:38 Differential cyanosis / Reverse differential cyanosis
07:52 The A, B, C causes of cyanosis
11:52 CHD risk factors
13:07 Physical exam
18:26 CCHD
19:23 Infant transported to NICU, now what?
22:26 Chest X-ray views (egg on a string, boot shaped, snowman?)
25:44 Oxygen support
26:52 Prostaglandin
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Music: www.bensound.com (royalty free with credit)
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*Disclaimer*: This video is intended for educational purposes only and while
we strive to give the most accurate information, errors may occur. Subsequently,
this video should not be a replacement for medical advice.
This video is extremely helpful with understanding all the different CHD that I’m currently seeing in our unit here in south Tx. Can’t wait for more videos on other CHD! Thank You for taking the time to teach us, your amazing. ❤
Oh Yay! Hi to South Texas! So glad that it was helpful- we are slowly getting these videos out. Thanks so much for your support :)
This is one of my favorite neonatal topics, extremely important! Looking forward to watching the rest of this series... Thank you, as always, for your awesome video lessons!
I'm with you! Love the physiology of it all! Thank you so much for your support!
You are a great teacher . It’s more exciting to learn from a beautiful teacher . Very attractive personality
Thank you!
Best teacher ever❤
Ohhhh wish this were true! But thank you!
really found this video to be helpful! it's like rounding with you and learning what it would take years to learn in a few minutes. thanks for explaining your thought process and logic. i am so grateful for you!
We are so grateful for your comments and that lovely compliment! Trying to fill the gaps in people's NICU education is what we set out to do!!! THANK YOU JH!
More videos on heart anomalies!!! You AND YOUR TEAM ARE SO AWESOME!!!
Thank you so much Katherine!!!! Comments like yours keep us going (literally!). We’ll get back to cardiac stuff- I don’t think we’ve figured out ideal way to film yet! Any ideas would be welcome!
Thank you Tala and the whole team for your wonderful videos! They are amazing! It would be so nice if you can mention which are your top books for Neonatology! Paula from Latvia:)
Hi Paula- so happy you're watching from Latvia! I don't think you're the first who has told us that is where they're from :) Thank you for your lovely comments. And yes- going over our favorite books is a GREAT idea!!!! Thanks!!!
Big love from me ❤.great teacher
Thank you so much- what a lovely compliment :)
Another amazing presentation/video, you always hit the mark, this topic is so important the review is really appreciated, thanks again to you and your team :)
Oh thank you- I always feel like the video doesn't get the stamp of approval until you comment :) We can't thank you enough for being here :)
Wow it really helpful thank you very much
Fantastic! Thanks so much for letting us know :)
Thanks for your efforts.
Very helpful revision notes.
Thank you so much for being here and for taking the time to write a positive comment to us! Keeps us going!
Thank you Dr. Tala for these videos! Amazing provider!😃
Thank you so much for continuing to support us Kyle- we always love your comments :)
Lots of great nuggets of info i'll keep in mind for now on when assessing the babies
Thank you!
Oh so happy you think so- thanks for subscribing and for taking the time to write in :)
Another interesting topic! I was taking care of a baby who was on HFNC 50%, echo report came back TPAVR, MD told RT go down to 21%, and I was so scared cuz kid color dramatically changed! U explain well enough why high O2 is useless on this type of cardiac case. Thanks again!
Yes Beverly! Exactly! (Although hopefully color didn't change too much!!). Love that you made this clinical correlation- thanks for letting us know :)
@@TalaTalksNICU color wasn't that bad, typical kid had that dusky grayish look but kid when into surgery a couple of days after.
yes! Know exactly what you mean! Hope baby OK now
Thanks again for the video Dr Tala. Always following your work.
Thank you so much Felipe- really love your comments :)
This z very helpful, thanks Dr Tala
So glad you found it helpful! Thanks so much for letting us know :)
thanks dr tala,.. please cover metabolic diseases of nb thanks
Ooh im sorry! I know we promised this already/ it’s near the top of our list! Thanks so much for watching and for your suggestion :)
Love the way you make everything supereasy! Could you maybe do a video on approaching a baby with suspected inborn error of metabolism? Thank you.
Hello! Thanks so much for the lovely compliment- we have been asked this a couple of times-n and we REALLY need to get it out!!! Thank you for the reminder and for watching!!!
@@TalaTalksNICU So happy to hear back from you. God bless you and your team for working so hard
Thanks
Thank you for watching!
Thank you Dr Tala! Very helpful for me !❤
SO glad was helpful Tina- thanks again for being here :)
Dear Dr. Tala,
Thank you so much for this video. I really enjoy your channel and admire your work.
I was wondering, when you talk about the hyperoxia test and measuring the PaO2 does that mean that you always put an arterial catheter or take arterial blood gazes on those babies you start to evaluate? I feel like we do the test by simply looking at the SaO2.
My other question is: do you maintain babies NPO until surgical repair? We sometimes keep enteral nutrition as it seems to be controversial but we don't have a lot of cardiac babies as they are almost all directly transferred in the PICU where I work.
Love sharing about NICU stuff :-)
Again thank you for your work
These are SUCH good questions Jessica.
So first you're right- often you can figure out what's going on with the sats. (You're putting a baby on 100% fi02 and the sats are in the 70s- that's leading you down the pathway of a bad cardiac disease or a lung disease). But what can be confusing is that even at a sat of say 95%- the pa02 can be anywhere between 100-600 - because this measures the amount of oxygen dissolved in blood, and the saturation measure how many oxygen molecules are attached to the hemoglobin molecules. So you could have a saturation of say 95% and this won't necessarily let you know how much Oxygen is really dissolved in blood- so in a way it's a lot more sensitive. Honestly- we really don't do the hyperoxia test often- because by definition in the US at least, we should be able to get echos done pretty quickly on level 2-4 NICUS.
And second question- also endlessly debated! Do we feed babies who are probably ductal dependent util surgery. The answer is usually yes- even if it is trophic feeds (
It's a request mam, can you please complete your cardiology series first with special emphasis on CHD, it's embryology and physiology.. thank you
We're slowly going through it- so far we've done the 5Ts video and ToF part 1. We'll get there!!
Thank you Dr Tala 😊
Thank you or continuing to watch :)
Excellent video ..thanx alot
So glad you liked it! Thank you!
Thanknu so much doc,bery appreaciated
Thank you so much for watching :)
Hey Tala! Question! Working up in the north doing aeromedical transport for rural communities. We do not have access to UACs or peripheral arterial lines, we rely on cap gasses - is there still any indication or benefit to doing a hyperoxia test? Would it be appropriate to proxy pre/post ductal SPO2 values and failure to reverse cyanosis as a way to confirm CHD? My impression is that a venous gas would be entirely useless, but perhaps a cap gas would better correlate to the PaO2?
It's my understanding in a normal neonatal transition, oxygen tension plays a role in closing the ductus arteriosus - would giving high FiO2 worsen CHD conditions and potentially close the ductus arteriosus, despite the potential inability to increase PaO2 with the circulatory abnormalities?
All of this to say, if doing a hyperoxia test would provide me with no real diagnostic results that are better than a high index of suspicion for CHD, and doing the test may cause harm and actually do the opposite of what we are trying to accomplish with PGE1, would it then be better to work the differential and rule out respiratory conditions first and assume by default CHD (and maybe sepsis) afterwards?
Thanks for the awesome video!
oh what a fantastic question (and brilliantly worded too btw). I probably should have said something about this! A cap gas may provide information of the pa02 is higher, but if it is low-it would offer nothing. (They are better correlated than venous but can still be wildly inaccurate) And also agreed- giing high fi02 is a good way to help the ductus close- so in your situation, I wouldn't attempt the test at all. Based on the clinical picture and X-rays- if you still think there's a high chance this is cardiac- then just start PGE. Given its potential for saving lives- the side effects are minimal.
Thank you for the great question and for all that you do for the babies. Stay safe out there!!!
@@TalaTalksNICU Awesome, thank you so much! This is honestly so amazing to watch your videos and have our questions answered, it's like having a neonatology consult that you can replay! I'm sharing your videos with my colleagues in the Yukon and referencing your material pretty frequently, so thanks again. Let me know if there's other ways to support your channel or practice! Cheers
Thank YOU so much Jill! Maybe one of these days we could chat about a video specifically made for transport??!
You’re amazing!!!
Nope! But glad you liked it :)
Thank you so much.
Thank YOU so much for watching all of these :)
When my son was a baby he would turn blue when crying. He would breath in and pause (holding breath) and I could see the blue color building. He would then let out the scream. Doctor said it was a heart murmur. He had surgery at age 2 I think. Fast forward now and he’s been getting dizzy when he stands (not quick, I might add) doc said it’s because Hes growing fast and his heart has to catch up. 15 and still growing 6’1.25 6’5 wingspan only 130 pounds. Yesterday at practice he showed me his arms after baseball and his hands and forearms were blue! He has fair skin but this was so noticeable. He use to have no breathing issues up until age 10 when he had a virus. After that he had a hard time, and still does keeping up on a basketball court. He was active and in great shape then. Doctor said it was the virus but I don’t think he ever fully healed.
JS- the arms turning blue and the dizziness does not sound right. (Maybe it is a variation of normal but you need to make sure). If he had heart surgery in the past, I would recommend he goes to a heart doctor (cardiologist). This is out of our expertise, but we wish you luck. He sounds like an impressive young man.
Why Right sided lesion cause hypocalcemia?
Thank you for your brilliant vedios❤😊😊
Hello! Sorry it wasn’t well explained! Right sided heart lesions/ right sided aortic arch- are more likely to have digeorge syndrome- which also presents with hypocalcemia. If they don’t have digeorge then won’t have hypocalcemia!
Thank you, please steps ti interpretation chest X-ray of newborn
That is an excellent suggestion- we'll add it to the list!
Treatment of polycythemia please
OOOHH that's interesting- we've moved away from partial exchange transfusions- maybe check out the CBC lectures? we touched on this there. Maybe we should do a quick nugget on this though! Thanks for the suggestion :)
after a c-section under general anesthesia (general because of risk avoidance of mothers herniated, cerebellum, and brainstem)at 38weeks 0days, labor never started head not engaged, mother was preeclamptic. Nonemergency but still delivered.
What would cause extensive bruising everywhere and petechia? 4+ minutes delay after membrane incision?
Hello! This was from a couple of days ago but I'm guessing you probably have an answer by now. I would guess NAIT causing low platelets? Is baby OK?
@@TalaTalksNICU I do not have an answer. I have full records. I would in a very unfortunate, desperate state, give anything to share my records and have them interpreted. is that possible? Is there an email? I can send some information to an email and get an opinion for personal understanding? 🙏
Hello good afternoon can i ask some question my baby have congenital heart disease and cyanotic type
Hello! Were not allowed to give specific advice but I can talk in generalities if that helps!
👌👏
Thank you :)
ᵗʰᵃⁿᵏ ʸᵒᵘ! ʷʰᵃᵗ ᵃ ᵍʳᵉᵃᵗ ʳᵉᵛⁱᵉʷ!
So glad you think so- thanks so much for being here!
Love u
We love you too! ha!