A 10-day-old term male neonate is brought to the emergency department by his parents. Their concerns are that, over the course of the day, he has become pale, his feet look “bluer”, and he is more lethargic. Moreover, he has only made 1 diaper today and is feeding very poorly. On examination, this is a very sick child presenting with tachycardia, tachypnea, peripheral cyanosis, weak femoral pulses, and a BP gradient (secondary to coarctation of the aorta). The child is in cardiovascular shock secondary to closure of the ductus arterosus. He needs to be given prostaglandins and oxygen, IV access, and cardiovascular and respiratory monitoring. He also needs to be referred to a pediatric cardiologist for further management and a pediatric intensivist for admission.

Goals & Objectives

Learning Objectives:

CRM Objectives:

Effectively lead a neonatal resuscitation and seek input from others
Use effective communication strategies, including closed loop communication and summarizing events for team
Recognize unique transport requirements of children with congential heart disease requiring resuscitation. These likely require referral to a regional cardiac care facility

Medical Objectives:

Recognize cardiovascular shock in the neonate
Develop differential diagnosis for cyanosis and cardiovascular shock in the pediatric population
Work-up for cyanosis and cardiovascular shock
Management of pediatric patient in cardiovascular shock

Details

Simulation Modality:

Manikin-based

Evalution/Validation:

We have run this case several times at Joseph Brant Hospital which has led to serial revisions of the case. This includes emphasizing the push/pull method for rapid fluid administration, adjusting the dosing of boluses and revising the need for pressors depending on the case progression (i.e. the recognition of  a closing patent ductos arteriosus).

Sharing

Citation:

Ong K, Nagji A, Ranganathan M, Leung J. Cardiovascular shock in the infant (from Coarctation of the Aorta). Simulation resource published by Simulation Canada; 2021. Available from https://simulationcanada.ca/scenario/cardiovascular-shock-in-the-infant-from-coarctation-of-the-aorta/.

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License:

The information about this resource and any downloadable files are shared under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.