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CONGESTIVE CARDIAC FAILURE in children : Short summary



           
CONGESTIVE CARDIAC FAILURE
Evaluation
H/O breathing difficulty, tachycardia, hepatomegaly, crepitations at lung bases, cardiomegaly, edema and ascites.

Investigations

CBC, ESR, Chest X-ray, ECG, Echocardiography, ABG, cardiac enzymes, serum electrolytes, ASOT, CRP and blood culture, urine examination, urea and creatinine where indicated.
   


General Measures

·         Admit
·         Oxygen inhalations
·          Prop up position 20-30°
·         Maintain IV line
·         Salt restriction
·         Vitals signs 1 hourly for 24 hours (until patient becomes stable)
·         Intake output records
·         Fluid restrictions 2/3 rd of daily requirements
·         Treat underlying infections with antibiotics

Specific measures
·         If HB < 12 g%, give packed cell transfusion10 ml /kg slowly.
·         Diuretics.  Furosemide 2 mg/kg/dose I.V stat then 2 mg/kg/day in 2 divided  doses
Spironolactone 2-4 mg/kg/day in 2 divided dose
·         Digoxin                 total dose =0.04 mg/kg/day
Maintenance dose = 0.01 mg/kg/day
Rapid Digitalization total dose is 0.04 mg per kg 50% dose given IV initially followed by 25% of total dose) after 6-8 and hours and 25% after 16 hours .

                                               
·         Dopamine 5 micro gram/kg/minutes to improve renal perfusion and
·         Dobutamine 10-25 kg/minutes for inotropic effect.
·         Vasodilators  (captopril 1 -5 mg/kg/day) reduce after load  by peripheral vasodilatation,


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