Managing a ‘tet spell’ (In sequence of escalation) 27 January, 201611 July, 2021 EMKF Knee to chest position (increases PVR). IV/IM/SC morphine (0.1-0.2mg/kg) Fluid bolus (10-20cc/kg) IV beta blockers, i.e. propranolol – decrease RVOT spasm Phenylephrine – increase PVR. Emergent surgical repair or shunt. ~ Neonates may need prostaglandins if they are dependent on their ductus arteriosus.