STARS Train the Trainer Class (TtT)

Intro to CHD

Pdf Summary

This EMS-focused document introduces congenital heart defects (CHDs), emphasizing recognition, initial assessment, and transport priorities. CHDs occur in about 1% of U.S. newborns, and roughly 25% are “critical,” requiring intervention within the first year (estimated 38,000 CHD and 9,500 critical CHD cases annually). Although many CHDs are detected prenatally or by newborn screening (including pre-/post-ductal oxygen saturation checks using the right hand and a foot), EMS may still encounter “unknown CHD,” particularly with homebirths or limited prenatal care.<br /><br />The presentation differentiates acyanotic lesions (e.g., ASD, PDA, VSD, AV canal, pulmonary stenosis) from cyanotic lesions (including the “T” lesions such as transposition of the great vessels and tetralogy of Fallot, plus HLHS and others). A key concept is ductal-dependent lesions: as the ductus arteriosus closes (stimulated by higher oxygen), some defects decompensate because systemic or pulmonary blood flow depends on the ductus. Prostaglandin E1 (PGE1) is highlighted to maintain/reopen ductal flow, with dosing guidance (commonly 0.05 mcg/kg/min when ductal status is unknown, titratable up to 0.1).<br /><br />Two major defects are reviewed. VSD is the most common acyanotic lesion; large left-to-right shunts can cause pulmonary congestion, pulmonary hypertension, heart failure, and feeding/growth problems. Tetralogy of Fallot is the most common cyanotic lesion; “tet spells” (hypercyanotic episodes triggered by stressors) are treated with knee-to-chest positioning, careful use of oxygen, and sedation/narcotics as needed.<br /><br />HLHS is presented as a staged surgical physiology (Norwood, Glenn, Fontan). Many children remain medically complex after repairs and may have baseline low saturations, oxygen needs, medications, or long-term complications.<br /><br />The takeaways stress structured pediatric assessment (airway/breathing/circulation/glucose/temperature), cautious oxygen use (don’t over-treat a single SpO₂; unknown cyanotic baseline may be 75–85%), small fluid boluses with reassessment, calming distressed children, caregiver communication, and early transport to tertiary centers.

Keywords

congenital heart defects (CHD)

critical CHD screening

cyanotic vs acyanotic lesions

ductal-dependent lesions

ductus arteriosus closure

prostaglandin E1 (PGE1) infusion

ventricular septal defect (VSD)

tetralogy of Fallot (TOF) tet spells

hypoplastic left heart syndrome (HLHS) staged palliation

pediatric EMS assessment and transport priorities