Anoxic spell by asogwa innocent kingsley
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ANOXIC SPELL
PRESENTED BY :ASOGWA INNOCENT KINGSLEY
ML508
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DEFINITION
Anoxic spells Anoxic spells (synonyms- hypoxic, (synonyms- hypoxic, hypercyanotic, blue, tet ) hypercyanotic, blue, tet ) – paroxysmal attack of – paroxysmal attack of dyspneadyspnea
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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
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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.
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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.
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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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DIAGNOSIS� AnamnesisAnamnesis� Physical examinationPhysical examination
� EchocardigraphyEchocardigraphy
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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
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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
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THANK YOU FOR YOUR ATTENTION