A 4-year-old child with Tetralogy of Fallot is brought to the emergency with severe cyanosis, deep breathing, and altered sensorium during a crying spell. Which of the following is NOT a component of the management of a hypercyanotic ('Tet') spell?

• A IV furosemide to reduce right-sided preload ✓
• B Knee-chest (squatting) position
• C Morphine sulfate administration
• D IV phenylephrine (alpha-agonist)

Explanation

Furosemide is contraindicated in a hypercyanotic spell because it reduces preload and venous return, worsening the functional right ventricular outflow tract obstruction and the right-to-left shunt. Management of a Tet spell involves: knee-chest position (increases systemic vascular resistance, reduces right-to-left shunt), IV morphine (reduces hyperpnea and sympathomimetic effect on RVOTO), IV phenylephrine (increases SVR), IV propranolol (reduces RVOTO), IV fluids (increases preload), and oxygen. Furosemide would exacerbate hypovolemia and worsen the spell.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.