What happens in a Tet spell?

A tet spell is an episode in which a child or infant becomes extremely blue and frequently agitated and out of breath. The spell is caused by a relatively sudden decrease in blood flow to the lungs. Tet spells can be precipitated by a number of things, including dehydration, agitation, or fever.

Does tetralogy of Fallot cause hypoxia?

When missed by screening, patients with Tetralogy of Fallot typically develop increasing hypoxia as their ductus arteriosus closes and they have progressive right ventricular outlet obstruction.

What is a TOF spell?

Information for parents and carers Page 2 Children with TOF may have a period where they become irritable with uncontrolled crying, have rapid and deep breathing and become very blue or pale /grey and floppy. This is called a hypercyanotic episode or ‘spell’.

What causes tet spells in TOF?

Tet spells are caused by a rapid drop in the amount of oxygen in the blood. Tet spells are most common in young infants, around 2 to 4 months old. Toddlers or older children might instinctively squat when they’re short of breath. Squatting increases blood flow to the lungs.

Why does squatting help tet spells?

The children with tetrology of Fallot and related conditions have baseline hypoxia due to right to left shunting . This gets aggravated during exertion. Squatting promptly relieves this exercise-induced worsening of dyspnea. The oxygen saturation improves immediately after assumption of squatting posture.

How do you relieve tet spells?

Place infants with hypercyanotic spells in the knee-chest position and give oxygen; sometimes, opioids (morphine or fentanyl), volume expansion, sodium bicarbonate, beta-blockers (propranolol or esmolol), or phenylephrine may help.

How does knee chest position help in TOF?

Bring the child’s knees up tight against his or her chest (this is called the knee-chest position) or have your child squat down. This will increase blood flow to the lungs. Try to calm your child.

How do you reduce hypoxic spells?

Management of Hypercyanotic Spell – Decrease PVR, Increase SVR, Improve PBF.

  1. Knee-Chest Position (increases Preload and increases SVR) Can even compress abdominal aorta to increase SVR more.
  2. Calm the child.
  3. Oxygen.
  4. Morphine (calms, decreased tachypnea, and also decreases PVR)