Tet spells (hypercyanotic spells) in TOF are treated in a stepwise fashion. Which combination correctly represents the correct management sequence?

• A Knee-chest position → oxygen → IV morphine → IV propranolol → IV phenylephrine if refractory ✓
• B Supine position → oxygen → IV morphine → propranolol → phenylephrine
• C Oxygen → IV digoxin → IV furosemide → knee-chest position
• D Knee-chest position → IV atropine → O2 → IV isoproterenol

Explanation

Management of a Tet spell: (1) Knee-chest position (increases SVR and venous return); (2) Supplemental oxygen; (3) IV/IM morphine (reduces hyperpnea and sympathetic response); (4) IV propranolol (relaxes infundibular spasm); (5) IV phenylephrine (increases SVR) or IV ketamine if refractory; (6) Bicarbonate for metabolic acidosis. Digoxin is contraindicated (can worsen infundibular spasm). Atropine would worsen tachycardia and isoproterenol reduces SVR.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.