Managing a ‘tet spell’ (In sequence of escalation)

  1. Knee to chest position (increases PVR).
  2. IV/IM/SC morphine (0.1-0.2mg/kg)
  3. Fluid bolus (10-20cc/kg)
  4. IV beta blockers, i.e. propranolol – decrease RVOT spasm
  5. Phenylephrine – increase PVR.
  6. Emergent surgical repair or shunt.

~ Neonates may need prostaglandins if they are dependent on their ductus arteriosus.

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