STARS Train the Trainer Class (TtT) - Beta-Intro to CHD for EMS with Instructor Notes (TtT)

Intro to CHD for EMS with Instructor Notes (TtT)

Pdf Summary

This EMS-focused presentation introduces congenital heart defects (CHDs), emphasizing how they present in the field and what initial management and transport priorities should be. CHDs occur in about 1% of newborns, and roughly 25% are “critical” lesions requiring intervention within the first year. While undiagnosed CHD is increasingly rare due to prenatal ultrasound and newborn pulse-ox screening (pre/post-ductal saturations: right hand and a foot), EMS may still encounter it in homebirths, poor prenatal care, or unrecognized pregnancies.<br /><br />The lecture differentiates acyanotic lesions (e.g., ASD, PDA, VSD) from cyanotic lesions (including several “T” diagnoses such as Tetralogy of Fallot and Transposition). A key concept is ductal-dependent lesions: as the ductus arteriosus closes (stimulated by higher oxygen after birth), some left-sided obstructive lesions need it for systemic blood flow and some right-sided obstructive lesions need it for pulmonary blood flow. Prostaglandin E1 (PGE1) is highlighted as therapy to maintain/reopen ductal patency.<br /><br />Two major examples are reviewed. Ventricular septal defect (VSD), the most common acyanotic lesion diagnosed in infancy, typically becomes symptomatic at 2–6 weeks as pulmonary vascular resistance drops, leading to pulmonary overcirculation and potential heart failure with poor feeding, sweating, irritability, and poor growth. Tetralogy of Fallot (ToF), the most common cyanotic CHD, can cause hypercyanotic “tet spells” triggered by stress; treatment emphasizes calming the child, knee-to-chest positioning, cautious oxygen use, and sedation/analgesia as needed.<br /><br />Hypoplastic left heart syndrome (HLHS) is explained as a staged surgical pathway (Norwood, Glenn, Fontan), with ongoing home monitoring, medications, and variable baseline oxygen saturations. Takeaways stress thorough assessment beyond SpO2, small fluid boluses with reassessment, recognizing atypical pediatric edema sites, strong caregiver communication, and preferential transport to tertiary pediatric cardiac centers.

Keywords

congenital heart defects

EMS pediatric cardiology

ductal-dependent lesions

prostaglandin E1 (PGE1)

pulse oximetry screening preductal postductal

acyanotic heart lesions (ASD PDA VSD)

cyanotic heart lesions Tetralogy of Fallot Transposition

ventricular septal defect heart failure symptoms

tet spells knee-to-chest management

hypoplastic left heart syndrome Norwood Glenn Fontan