S.T.a.B.L.E. - Cardiac Module: Recognition and Stabilization of Neonates with Severe CHD

Dr Karlsen is a neonatal nurse practitioner who has been involved in neonatal care in a variety of settings including transport, education, patient care, and simulation for more than 35 years. She is the founder of the internationally recognized S.T.A.B.L.E. Program and author and developer of The S.T.A.B.L.E. Program Pretransport / Postresuscitation stabilization neonatal education course, The S.T.A.B.L.E. –  Cardiac Module course (book and slide program), the STABLEize™ app (for Apple and Android), The S.T.A.B.L.E. Program’s Gestational Age and Physical Assessment of the Newborn slide program, and the Neonatal Stabilization Scenarios Guidebook, based on The S.T.A.B.L.E. Program curriculum. More than 650,000 students have completed a S.T.A.B.L.E. Program course, and the Program is taught in more than 45 countries.Dr Karlsen serves as the Program Director for S.T.A.B.L.E., and she travels domestically and internationally to teach The S.T.A.B.L.E. Program curriculums and Instructor Courses. Since 1985, her clinical affiliation is the Level 4 neonatal intensive care unit at Intermountain Healthcare Primary Children’s Hospital in Salt Lake City, Utah, where she serves as a neonatal nurse practitioner on the cardiac patient team.Dr Karlsen is the recipient of numerous awards and recognition: the AWHONN/Johnson & Johnson 2003 Childbirth Nursing Award, the March of Dimes 2004 Leadership in Healthcare Nurse Award, the University of Utah College of Nursing 2005 Outstanding Doctoral Student Award, the 2010 National Association of Neonatal Nurse Practitioners NNP Excellence Award, and the 2014 National Perinatal Association, The Individual Contribution to Maternal & Child Health at the National and International Level Award. In 2019, she was awarded a Fellowship in the American Academy of Nursing to recognize her worldwide impact on improving neonatal outcomes through the S.T.A.B.L.E. Program’s interprofessional neonatal education.  Collin G. Cowley, MD, joined the faculty of the University of Utah in 2000 after completing fellowships in pediatric cardiology and interventional catheterization at the University of Michigan. Over the next 20 years, he pursued his interests in clinical care, research, education, and clinical administration and was promoted to tenured Professor in 2013. Dr Cowley is a fellow of the American Academy of Pediatrics and the American College of Cardiology. Dr Cowley remains passionate about patient care and recently retired from the University of Utah to join Mednax Health Solutions in opening several pediatric cardiology offices in northern Utah.

This is a unique book and course that has been taught for over 30 years as an adjunct to the Neonatal Resuscitation Program. This second edition of the cardiac module is a welcome update of the 2003 original. It has easily understood illustrations and directions to help providers treating newborns with CHD prior to transport. It is an excellent teaching tool and will find multiple uses in the education of neonatal providers."- Doody's 4-Star Review (Jay P. Goldsmith, MD, Tulane University School of Medicine)

• Acronyms Used in this BookIntroductionPart 1 History and Patient AssessmentIncidence of Congenital Heart Disease (CHD)History and Patient PresentationNeonatal HistoryPregnancy, Labor, and Delivery HistoryMaternal Medical HistoryRecurrence RiskPatient AssessmentNeurologic StatusPhysical Appearance – Size and FeaturesInfant of the Diabetic Mother (IDM)Small for Gestational Age (SGA) InfantsSyndromes and Chromosomal Abnormalities Associated with CHDTrisomy 21 (Down Syndrome)Trisomy 18 (Edwards Syndrome)Trisomy 13 (Patau Syndrome)What does it mean? Let’s talk about a persistent Patent Ductus Arteriosus (PDA)Monosomy X (Turner Syndrome – XO chromosome)CHARGE SyndromeVACTERL Association22q11 2 Deletion Syndrome (22q11 2DS)What does it mean? ConotruncalColorOxygen SaturationVital Signs - Respiratory Rate and EffortVital Signs – Heart Rate and RhythmTreatment of SVTAdenosineVital Signs – Blood Pressure (BP)ShockBruitPulsesSkin Perfusion and AppearancePrecordial ActivityHeart SoundsHeart MurmurLiver Size and LocationWhat does it mean? Situs solitus, situs inversus, and heterotaxyDiagnostic TestsDifferential DiagnosisPart 2 Clinical Presentation and Stabilization of Neonates with Severe CHDWhat does it mean? Let’s talk about CHD that is ductal dependentPharmacology – Prostaglandin E1 (PGE, Alprostadil, Prostin)Left-Sided Obstructive Lesions, Ductal Dependent for Systemic Blood FlowUnderlying ConceptsCoarctation of the AortaInterrupted Aortic ArchAortic Valve StenosisHypoplastic Left Heart SyndromeLeft-sided Obstructive Lesions – Clinical PresentationLeft-Sided Obstructive Lesions – Chest X-RayLeft-sided Obstructive Lesions – Initial StabilizationCase Study: 1-Day old infant with HLHSCyanotic Congenital Heart Disease, Not Ductal Dependent for Pulmonary Blood FlowUnderlying Concepts and Stabilizing the Cyanotic Neonate with Suspected CHDTetralogy of FallotTetralogy of Fallot – Clinical PresentationTetralogy of Fallot – Chest X-RayTetralogy of Fallot – Initial StabilizationWhat does it mean? Let’s talk about hypercyanotic/tet spellsHypercyanotic/Tet Spell – Treatment PrinciplesWhat does it mean? Let’s talk about Double Outlet Right Ventricle (DORV)Tricuspid AtresiaTricuspid Atresia – Clinical PresentationTricuspid Atresia – Chest X-RayTricuspid Atresia – Initial StabilizationTruncus Arteriosus Truncus Arteriosus – Clinical PresentationTruncus Arteriosus – Chest X-RayTruncus Arteriosus – Initial StabilizationTotal Anomalous Pulmonary Venous ConnectionSupracardiac TAPVCCardiac TAPVCInfracardiac TAPVC (also called infradiaphragmatic)Total Anomalous Pulmonary Venous Connection – Clinical PresentationTotal Anomalous Pulmonary Venous Connection – Chest X-RayTotal Anomalous Pulmonary Venous Connection – Initial StabilizationEbstein AnomalyEbstein Anomaly – Clinical PresentationEbstein Anomaly – Chest X-RayEbstein Anomaly – Initial StabilizationCyanotic Congenital Heart Disease, Ductal Dependent for Pulmonary Blood FlowUnderlying ConceptsStabilizing the Cyanotic Neonate with Ductal Dependent Pulmonary Blood FlowPulmonary Atresia with Intact Ventricular Septum (PA-IVS)Pulmonary Atresia with Intact Ventricular Septum (PA-IVS) – Clinical PresentationPulmonary Atresia with Intact Ventricular Septum (PA-IVS) – Chest X-RayPulmonary Atresia with Intact Ventricular Septum (PA-IVS) – Initial StabilizationWhat does it mean? Let’s talk about PA-IVS and Ventriculocoronary ConnectionsPulmonary Atresia and Ventricular Septal Defect (PA-VSD)Pulmonary Atresia and Ventricular Septal Defect (PA-VSD) – Clinical PresentationPulmonary Atresia and Ventricular Septal Defect (PA-VSD) – Chest X-RayPulmonary Atresia and Ventricular Septal Defect (PA-VSD) – Initial StabilizationTransposition of the Great Arteries (TGA)Transposition of the Great Arteries – Clinical PresentationTransposition of the Great Arteries – Chest X-Ray Transposition of the Great Arteries – Initial StabilizationWhat does it mean? What is the difference between D-TGA and L-TGA?Part 3 S.T.A.B.L.E. – Cardiac ModuleIntroductionSugar and Safe Care ModuleGlucose Production and Utilization RateInitial IV Fluid Rate and Target Glucose LevelsIV Access and Central LinesUmbilical Vein Catheter (UVC)Umbilical Artery Catheter (UAC) and Peripheral ArterialUmbilical Catheter SafetyPeripherally Inserted Central Catheter (PICC)Temperature ModuleAirway ModuleO2 Saturation, Hemoglobin, and CHDO2 ContentWhat does it mean? What is Regional Oximetry Monitoring – Near Infrared Reflective Spectroscopy (NIRS) Monitoring?Pulse Oximetry Screening (POS) for Critical Congenital Heart Disease (CCHD)Blood Pressure ModuleMethods for Measuring BPOscillometric Measurement – How Does it Work?Lab Work ModuleBlood SugarBlood GasLactic Acid/LactateElectrolytes and Renal Function TestsIonized CalciumMagnesiumLiver Function TestsComplete Blood Count with DifferentialCardiac Enzymes: B-Type Natriuretic Peptide (BNP) and Troponin IWhat does it mean? Let’s talk about Genetic TestingEmotional Support ModuleAppendix 1 – Palliative and Surgical Repair of the Lesions Discussed in this BookAppendix 2 – Medications Used in the Treatment of Neonates with CHDReferences Index