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Cardiac, Congestive heart failure, Acute rheumatic fever, Congenital heart…

- - - - If bleeding occurs, don gloves and place pressure approximately 1 inch above insertion site
  - - - NG tube for left over from bottle
- - - - Ventricular septal defect (need surgery if it doesn't close/ worse than ASD)
      - Patent ductus arteriosus (normal until first breath) (Prostaglandin E to open) (indomethacin to close)
      - Atrial septal defect (Usually close on its own) (Asymptomatic until 30/40 years old)
      - AV canal (can tolerate for a while but can't maintain)
    - - Aortic stenosis (Aortic valve is too tight = decrease cardiac output) (Suddenly die) (Family hx to ID)
      - Pulmonic stenosis (can by cyanotic)
      - Coarctation of aorta (perfuses to upper extremities then squeezes when it goes to lower extremities -> different BP and color top vs bottom) (fix by cut out or widden)
  - - - Tetralogy of Fallot (VSD + pulmonic stenosis + overriding aorta + right ventricular hypertrophy)
      - Tricuspid Atresia (No tricuspid valve) (want to keep PDA/ASD open
      - Hypercyanotic spells = Increased oxygen demand with limited pulmonary blood flow (Acute arterial oxygen desat, hypoxia, greater resistance to pulmonary blood flow) TREAT: knee to chest, camm/comfort, o2 not going to help, morphine sulfate (vasodilate), fluid replace if dehydrated
      - Fontan procedure = path to lung / bypass ventricle
    - - Transposition of great arteries (aorta carry deoxygenated blood) (keep PDA open with prostaglandins E)
      - Hypoplastic left heart syndrome (no left side of the heart) (staged surgery throughout life)
- - - - Leukocytes, CRP and ESR: elevated
      - RBCs decreased
      - Mitral valve murmur due to regurgitation
      - Gallop rhythm
- - - - Sepsis
      - Neurogenic
      - Toxic shock
        
        Pathogen induced overstimulation of immune system (hyperthermia, rash, hypotension, vasodilation, increased capillary permeability, multisystem failure
      - Endocrine shock
      - Anaphylaxis
        
        Exposure to an antigen
        
        Rapid generalized histamine release (vasodilation, bronchoconstriction, increased capillary permeability)
    - - Increased: perfusion appears adequate, HR, RR, Hyperthermia, warm extremities, brisk cap refill, CO
      - Decreased: slightly mental status changes (irritable, lack of interaction with parent) and systemic venous resistance (pooling)
    - - Increased: fever or hypothermia
      - Decreased: long cap refill, progressive mental status changes, extremities mottled and cool, HR, BP, UOP
  - - - Decreased: pulse strength, pale/mottled color, cool extremities
      - Increased: heart rate, respiratory effort, longer cap refill
      - BP normal because compensated
    - - Decreased: LOC, UO (not perfusing to kidneys), BP
      - Plus early signs
      - No treatment -> cardiopulmonary failure
    - - PRBCs depending on cause (crash)
      - Inotropic IV drips
      - IV fluid resuscitation: 20 mLl/kg bolus, NS, LR (counteracts acidosis)
    - - Capillary refill more brisk
      - Increased color and responsiveness
      - HR decreased to normal range