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Tetralogy of Fallot hypercyanotic spell — RACP Paediatrics MCQ

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HardCardiologyTetralogy of Fallot hypercyanotic spellRACP Paediatrics

A 10-month-old with unrepaired tetralogy of Fallot becomes deeply cyanosed and irritable after crying. Saturation is 58%, the systolic murmur is softer than usual and he draws his knees to his chest. What is the most appropriate management?

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Correct answer: E — Place knees to chest, give oxygen and urgent morphine-based spell management

A hypercyanotic spell causes acute reduction in pulmonary blood flow; knee-chest positioning, oxygen, calming and urgent medication such as morphine are appropriate. A softer murmur reflects reduced right ventricular outflow, not improvement. These spells are emergencies and require senior cardiology involvement.

Reference: RCH Cyanotic episodes guideline; RACP Knowledge Guides