low oxygen levels

Specialties Cardiac

Published

Hello, I'm an elementary school nurse and I have a student who has had 3 open heart surgeries for a heart defect, I don't know much else that is all the mom put on her medical history. One day I checked her oxygen level because she looked blue around the mouth and really pale and her oxygen level was in the 80's, her mom came to pick her up for something else nonrelated and I asked her about it and she said that was normal for her and she always runs in the 80's. She never has a problem with SOB and does physical activity without any trouble, so since I'm not a pediatric cardiology expert I was wondering if this is normal for some cardiac patients and why wouldn't they put her on O2?

Specializes in Pediatric Critical Care.
Hmm, now that we established that her saturation levels aren't too concerning and it's her baseline, what about her cyanosis? I mean if she's looking blue and pale, shouldn't something be done? I'm asking purely out of curiosity. I don't deal with pediatrics so if anyone can answer that would be great. Thanks!

Nope, they will often look dusky (aka blue), and can sometimes have clubbing of their nails as well.

Specializes in Pediatric Critical Care.
Albuterol is not a big deal. But supplemental oxygen is really opening a can of worms.

Speaking of albuterol: Had a newborn with congenital third-degree heart block admitted the other night. Isuprel/ Dopamine/Dobutamine/Epi maxed out. HR 50s. We all took a time out to make sure we were not missing something to help this kid before we could get her to surgery- and the intensivist looks at the RT and says (jokingly)"Let's try a 20 mg continuous neb!" We almost did it- just to see!

I'm surprised that you didn't externally pace the baby.

Also, fun fact: Congenital complete heart block, particularly in the absence of any structural heart abnormalities can be associated with maternal lupus (and potentially can help identify the disease in a previously undiagnosed mother.)

I guess it is normal lol you learn more everyday! :)

Specializes in PICU.

A couple of things that I wanted to clarify. Generally after the 3 stage palliation for single ventricle physiology they do have normal sats. If the Fontan is fenestrated they may be slightly lower, but they usually aren't 70's to low 80's anymore. The concern with oxygen administration isn't oxygen toxicity but vasodilation of the pulmonary arteries and subsequent pulmonary edema. However, if they have low oxygen sats, you still give them the oxygen they need, you just have to be mindful of possible consequences of it. And you target THEIR normal sats, not the usual >92%.

I agree you need to know what the defect is and what normal sats are for the child. You can't always treat the congenital heart kids like you do everyone else. So understanding the specific needs of this child will help you take care of him safely.

Specializes in Critical care.

Low SaO2 can be normal for the various reasons explained above. The one condition in which you may need to be concerned with the cyanosis around the lips is Tetralogy of Fallot, we used to call them "Tet spells" back in the 90s, not sure what the current nomenclature is. We used to hug the toddler to us with their knees to their chest, not sure if this is still current practice, but maybe one of the PICU posters will know. I am just an old man :-P

Cheers

Specializes in NICU, ICU, PICU, Academia.
I'm surprised that you didn't externally pace the baby.

Also, fun fact: Congenital complete heart block, particularly in the absence of any structural heart abnormalities can be associated with maternal lupus (and potentially can help identify the disease in a previously undiagnosed mother.)

She was literally on her way to the OR so pacing would have only delayed things. (Other issues made it impractical) And she also had other abnormalities- cardiac and otherwise.

Also, her HR had been in the 50-60 range during the entire prenatal period.

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