Kawasaki disease

Kawasaki disease is an uncommon childhood illness that causes inflammation of the blood vessels. It most commonly affects children ages 18 to 24 months; it is less commonly seen in people older than age 8. It tends to be severe for several days, but then most children return to normal activities. After your child gets better, the doctor will usually watch him or her for heart problems.

The disease is not contagious and occurs most often in the late winter and early spring.

What causes Kawasaki disease?

Although a specific cause has not yet been identified, researchers suspect Kawasaki disease may be related to a virus or bacteria.

Symptoms:

Symptoms of Kawasaki disease include:

A fever higher than (39º Celsuis) lasting at least 5 days. Red eyes. A body rash. Swollen, red lips and tongue. Swollen, red feet and hands. Swollen lymph nodes in the neck. sore, irritated throat

Diagnosis

Kawasaki disease can be difficult to diagnose. Although there is no specific test for Kawasaki disease, a diagnosis can be made if a child has a fever that lasts at least 5 days and also has 4 of the 5 other symptoms listed above. Less often, a diagnosis is made when a child has a fever that has lasted at least 5 days, two other symptoms from the list above, and some damage to the heart (coronary artery disease).

Treatment

Treatment for Kawasaki disease may include medicine given through a vein (intravenous, or IV, medicine) called immunoglobulin (IVIG) to reduce inflammation of the blood vessels, aspirin therapy to lower the risk of blood clots, and possibly blood thinners (anticoagulants) to prevent new blood clots.

Is Kawasaki disease serious?

Most children with Kawasaki disease get better and have no long-term effects, even if they do not receive treatment. However, treatment shortens the illness and greatly reduces the chances of having problems from Kawasaki disease.

About 20% of children who are not treated will have problems in the arteries that supply blood to the heart (coronary artery disease). Weakened coronary arteries may get enlarged or can narrow or develop blood clots. In very rare cases, this can lead to a heart attack.

The risk of heart attack is greatest within 1 year after the illness. However, studies in Japan indicate that children who develop coronary artery damage are more prone to having a heart attack as young adults.

Treatment Overview

Kawasaki disease is treated with medications. Long-term care may be needed and might include continued medication, limited physical activity, and repeated testing.

Early treatment of Kawasaki disease prevents most blood vessel and heart damage. If children with Kawasaki disease are hospitalized and treated within 10 days after the first signs of illness, the risk of heart disease and aneurysms greatly decreases.

Kawasaki disease is best treated by a pediatrician or cardiologist.

Medications

Medications used to treat Kawasaki disease include intravenous immunoglobulin (IVIG), aspirin, and possibly anticoagulants.

Intravenous immunoglobulin (IVIG). Intravenous immunoglobulin (IVIG) is used to reduce inflammation of blood vessels. IVIG usually is given in 1 dose through a vein, over 8 to 12 hours. The treatment usually requires that the child stay in the hospital for at least 24 hours. After IVIG treatment, the illness usually improves very quickly. IVIG works best if it is given before the tenth day of fever. Occasionally, a second dose of IVIG is needed because the first dose did not reduce the fever and inflammation.

Aspirin therapy. At first, high-dose aspirin is used to relieve inflammation and fever. If there are no complications, smaller daily doses are then given for 2 to 3 months to lower the risk of dangerous blood clots. Because of the risk of Reye's syndrome, aspirin should be given only under the guidance of a doctor. If the child is exposed to or develops chickenpox or flu (influenza) while taking aspirin, talk with a doctor right away. For more information, see the topic Reye's Syndrome.

Anticoagulants. Anticoagulants may be used if the child has a large aneurysm. Anticoagulants help prevent new blood clots.

After initial treatment, the child's fever and inflammation should improve, but the child may still be irritable, not have an appetite, and not be very active. The child may also develop deep lines across his or her fingernails (Beau's lines). It may be several weeks before the child feels completely well.

Follow-up treatment

If echocardiogram results from follow-up exams are normal, the child probably will not need further care.

However, if these test results show changes in the coronary arteries, long-term care of the disease may be needed. This care may include:

Repeated exams and tests every year or every 3 to 5 years, depending on the child's risk for heart problems. Continued low-dose aspirin therapy, sometimes combined with other medications that lower the risk of blood clots. Limited physical activity. Annual flu shot (influenza vaccine)

What to think about

Treatment with immunoglobulin (IVIG) sometimes interferes with the effectiveness of immunizations against measles, mumps, rubella (MMR) and chickenpox. MMR and chickenpox immunizations should be postponed for 11 months in children who have received IVIG treatment.

Kawasaki disease is an illness that involves the skin, mouth, and lymph nodes, and most often affects kids under age 5. The cause is unknown, but if the symptoms are recognized early, kids with Kawasaki disease can fully recover within a few days. Untreated, it can lead to serious complications that can affect the heart.

Kawasaki disease occurs in 19 out of every 100,000 kids in the United States. It is most common among children of Japanese and Korean descent, but can affect all ethnic group

Congestive Heart Failure

Heart failure, also called congestive heart failure, is a condition in which the heart cannot pump enough oxygenated blood to meet the needs of the body's other organs. The heart keeps pumping, but not as efficiently as a healthy heart. Usually, the loss in the heart's pumping action is a symptom of an underlying heart problem.

Causes of Cogestive Heart Failure?

Heart failure often occurs in children with congenital (present at birth) heart defects. Other medical problems that can cause heart failure include, but are not limited to, the following:

systemic right ventricle (right ventricle is the only ventricle or the right and left ventricles are transposed so that the right ventricle pumps blood out to the body rather than the lungs) that is unable to meet demand inefficient pumping of the ventricles due to enlargement of the heart and/or too much volume in the circulatory system heart valve disease caused by past rheumatic fever or other infections infections of the heart valves and/or heart muscle (i.e., endocarditis) cardiac arrhythmias (irregular heartbeats) cardiomyopathy, or another primary disease of the heart muscle chronic lung disease anemia high blood pressure (hypertension) hemorrhage (excessive bleeding) post-operative complications over time, following repair or palliation procedure(s)

Many congenital heart defects have the potential to lead to heart failure over time, whether or not the defect is treated surgically. Congenital heart defects that more often develop heart failure include, but are not limited to, the following:

transposition of the great arteries congenitally corrected transposition of the great arteries tetralogy of Fallot pulmonary stenosis Ebstein's anomaly of the tricuspid valve single ventricle aortic or mitral valve disease

Altered Physiology

Heart failure can affect the right side of the heart, the left side of the heart, or both sides.

When the right side of the heart begins to function less efficiently, it is unable to pump much blood forward into the vessels of the lungs. Because of the congestion in the right side of the heart, blood flow begins to back up into the veins. Eventually, swelling is noticed in the feet, ankles, eyelids, and abdomen due to fluid retention.

When the left side of the heart fails, it is unable to pump blood forward to the body efficiently. Blood begins to back up into the vessels in the lungs, and the lungs become stressed. Breathing becomes

faster and more difficult. Also, the body does not receive enough blood to meet its needs, resulting in fatigue and poor growth.

Symptoms of Congestive Heart Failure?

The following are the most common symptoms of heart failure. However, each child may experience symptoms differently. Symptoms may include:

visible swelling of the legs, ankles, eyelids, face, and (occasionally) abdomen fast breathing during rest or exercise shortness of breath or labored breathing fatigue a child needing to take frequent rest breaks while playing with friends nausea falling asleep when feeding or becoming too tired to eat lack of appetite weight gain over a short period of time, even when the appetite is poor cough and congestion in the lungs sweating while feeding, playing, or exercising breathing difficulty with activity, especially while feeding, walking, or climbing stairs) loss of interest in feeding (poor appetite, loss of muscle mass, overall weight loss) failure to gain weight swelling around the eyes or over the flanks (between the ribs and the upper border of the hip bone) abdominal distension (enlargement) and/or pain over the right side (liver area) change in skin temperature and color (cold and clammy, or sweaty, flushed, and warm)

The severity of the condition and symptoms depends on how much of the heart's pumping capacity has been affected.

The symptoms of heart failure may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

Diagnosis

Your child's physician will obtain a complete medical history and physical examination, asking questions about your child's appetite, breathing patterns, and energy level. Other diagnostic procedures for heart failure may include:

blood and urine tests chest x-ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. electrocardiogram (ECG or EKG) - a test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and detects problems with the heart muscle. echocardiogram (echo) - a noninvasive test that uses sound waves to produce a study of the motion of the heart's chambers and valves. The echo sound waves create an image on the monitor as an ultrasound transducer is passed over the heart.

Treatment of heart failure:

Specific treatment for heart failure will be determined by your child's physician based on:

your child's age, overall health, and medical history extent of the disease your child's tolerance for specific medications, procedures, or therapies expectations for the course of the disease your opinion or preference

If heart failure is caused by a congenital (present at birth) heart defect or an acquired heart problem such as rheumatic valve disease, surgical repair of the problem may be necessary. Medications are often helpful in treating heart failure initially. Eventually, medications may lose their effectiveness and many congenital heart defects will need to be repaired surgically. Medications may also be used after surgery to help the heart function during the healing period.

Medications that are commonly prescribed to treat heart failure in children include the following:

digoxin - a medication that helps strengthen the heart muscle, enabling it to pump more efficiently. diuretics - helps the kidneys remove excess fluid from the body. potassium-sparing diuretics - helps the body retain potassium, an important mineral that is often lost when taking diuretics. potassium supplements - replaces the potassium lost when taking diuretics. ACE (angiotensin-converting enzyme) inhibitors - dilates the blood vessels, making it easier for the heart to pump blood forward into the body. beta blockers - decrease the heart rate and blood pressure, and improve heart function by blocking the stress hormone adrenalin.

Cardiac resynchronization therapy, or device therapy, is a newer treatment for heart failure. Device therapy uses a type of pacemaker that paces both sides of the heart simultaneously to coordinate contractions and improve pumping ability.

Therapeutic Rationale * Reduce salt and water retention: Diuretics are the first line drugs for use in most uncomplicated cases of congestive heart failure. (Restriction of sodium intake is desirable but sometimes difficult to achieve.) Reduction of blood volume decreases the size of the heart, allowing it to function on a more favorable portion of the ventricular function curve, and reduces the intracapillary pressure that leads to edema.

* Increase the force of cardiac contraction: Positive inotropic drugs such as digitalis glycosides are effective in many cases of chronic failure and move the heart to a higher ventricular function curve. They are generally more toxic than the diuretics. Several positive inotropic substitutes for digitalis are available for use in special circumstances. * Reduce vascular tone: Vasodilators reduce the work of the heart and improve cardiac ejection and tissue perfusion. They are especially useful in acute failure, eg, that associated with myocardial infarction and severe hypertension

Mechanism * Diuretics: Their efficacy in congestive heart failure reflects the magnitude of the salt retention that occurs in failure. * Positive inotropic drugs: - Digitalis glycosides: Digitalis drugs act by inhibiting membraneNa,K-ATPase, thereby causing an increase in intracellular sodium. Increased intracellular sodium results in an increase in in tracellular calcium. The latter ion directly modulates the contractile process. - Sympathomimetics: Beta-1 adrenoceptor stimulants such as dobutamine and dopamine are valuable in some cases of acute failure since they increase cardiac contractility and cause some vasodilation. In favorable cases, increased contractility is not accompanied by significant tachycardia. - Amrinone, milrinone, methylxanthines, and other PDE inhibitors: These drugs cause an increase in cylic AMP by inhibiting cardiac phosphodiesterase. The increase in cAMP results in an increase in transmembrane calcium flux and a secondary increase in cardiac contractility. The same biochemical action increases cAMP in vascular smooth muscle and results in vasodilation.

* Vasodilators: Direct-acting agents (eg, nitrates, nitroprusside), sympathoplegics (eg, prazosin), and angiotensin converting enzyme inhibitors (eg, captopril) reduce cardiac workload and increase cardiac output in failure associated with high vascular pressures. Captopril also decreases aldosterone levels, thereby reducing salt and water retention.

Endocarditis

Endocarditis is caused by bacteria (or rarely, fungi) that enter the bloodstream and settle on the inside of the heart, usually on the heart valves. Bacteria can invade your bloodstream in many ways, including during some dental and surgical procedures. If you don't take care of your teeth, having your teeth cleaned or even brushing your teeth can cause bacteria to enter the bloodstream.

Risk for endocarditis

If you have a normal heart, you have a low risk for developing endocarditis. But if you have a problem with your heart that affects normal blood flow, it is more likely that bacteria or fungi will attach to heart tissue. This puts you at a high risk for endocarditis.

If you have certain heart conditions, getting endocarditis is even more dangerous for you. These heart conditions include:

Artificial heart valves. Endocarditis in the past. Heart defects since birth (congenital heart defects). Heart valve problems after a heart transplant.

Other risk factors that put you at risk for getting endocarditis include:

Having hypertrophic cardiomyopathy. Having hemodialysis, which is a treatment to clean the blood, for people with kidney failure. Injecting street drugs using dirty needles or without cleaning the skin.

Having AIDS. Acquired immunodeficiency syndrome reduces your ability to fight infection.

Some heart problems can put you at risk for endocarditis. These heart conditions include:

Artificial heart valves. Endocarditis in the past. Heart defects since birth (congenital heart defects). Heart valve problems after a heart transplant.

If you have any of these heart conditions, you may need to take antibiotics before you have certain dental and surgical procedures. The antibiotics lower your risk of getting endocarditis. These procedures include:

Certain dental work or dental surgery. Lung surgery. Surgery on infected skin, bone, or muscle tissue. Certain medical procedures, such as a biopsy.

Maintaining good oral hygiene is especially important to prevent endocarditis if you are at risk.

Your doctor can give you a card to carry in your wallet that states that you need preventive antibiotics before certain procedures.

What are the symptoms?

The symptoms of endocarditis progress as the bacteria or fungi grow in your heart. Vague, flu-like symptoms, such as a low-grade fever and fatigue, often occur first. Most people with endocarditis begin to have symptoms within 2 weeks after becoming infected with bacteria or fungi.

But a powerful strain of bacteria may cause symptoms to appear much faster, within a few days.

Symptoms include:

Chills and fever. Fatigue. Weight loss. Night sweats. Painful joints. Persistent cough and shortness of breath. Bleeding under the fingernails. Tiny purple and red spots under the skin, called petechiae.

Although symptoms are vague and may not seem worth telling your doctor about, if they don't go away or if you know you are at risk for endocarditis, contact your doctor.

If endocarditis is not treated, the bacteria that cause endocarditis can form growths on or around the heart valves. The growths prevent the heart valves from opening and closing properly. This interrupts the normal blood flow through the valves and interferes with the heart's pumping action. Blood can leak

backwards instead of being pumped forward. Over time, heart failure can develop because your heart may not be able to pump enough blood to meet your body's needs.

Endocarditis can also cause other problems, including:

Abnormal heartbeat. Stroke. Kidney failure.

Diagnoses

The doctor will ask about medical history and do a physical exam. If your doctor thinks that you may have endocarditis, he or she will check for signs of the infection, such as a heart murmur, an enlarged spleen, skin rashes, and bleeding under your nails.

Blood cultures will be done to check for bacteria in your bloodstream, and other tests, such as an echocardiogram, may be done to check your heart function and look at your heart valves.

It is important to treat endocarditis as soon as possible to avoid permanent damage to the heart muscle or heart valves.

Treatment

Antibiotics given through a vein (intravenously, or by IV) are the usual treatment for endocarditis. If your heart valves are damaged by the infection or if you have an artificial heart valve, surgery to repair or replace the valve may be needed. You may also need surgery if your endocarditis is caused by a fungus. If it is not treated, endocarditis can be fatal.

Antibiotic resistance

Antibiotic resistance occurs when bacteria (such as those that cause endocarditis) develop the ability to resist drugs that were previously able to kill them. Although antibiotic resistance is most common in situations that involve improper, unnecessary, and incomplete use of prescription antibiotics, resistance can also develop through correct antibiotic usage.

Antibiotic resistance is dangerous, because one type of bacteria can acquire the ability to survive certain drugs and then exchange this ability with other types of bacteria. When resistance to a particular medicine is widespread, the antibiotic becomes ineffective, and scientists must find an adequate replacement. Since the only way for bacteria to develop resistance is through exposure to these antibiotics, doctors try to use these drugs only when appropriate and necessary, reducing the chances of resistance.

Always attempt to prevent antibiotic resistance, since resistant bacteria are more dangerous to your valves. This can be done by:

Completing the course of drugs that you have been given. Antibiotics generally take several days to kill bacteria, and if you take a partial course, you are teaching bacteria to survive the antibiotic.

Not stockpiling partial prescriptions and self-dosing with antibiotics.

Rheumatic Fever

Definition   

Rheumatic fever is an inflammatory disease that may develop after an infection with Streptococcus bacteria (such as strep throat or scarlet fever). The disease can affect the heart, joints, skin, and brain.

Causes   

Rheumatic fever mainly affects children ages 6 -15, and occurs approximately 20 days after strep throat or scarlet fever. In up to a third of cases, the strep infection that caused rheumatic fever may not have had any symptoms.

About 3% of people with untreated strep infections get rheumatic fever. People who had a case of rheumatic fever are likely to develop flare-ups with repeated strep infections.

Symptoms   

Fever

Joint pain, arthritis (mainly in the knees, elbows, ankles, and wrists) Joint swelling; redness or warmth Abdominal pain Skin rash (erythema marginatum) o Skin eruption on the trunk and upper part of the arms or legso Eruptions that look ring-shaped or snake-like Skin nodules Sydenham's chorea (emotional instability, muscle weakness and quick, uncoordinated jerky

movements that mainly affect the face, feet, and hands) Nosebleeds (Epistaxis) Heart (cardiac) problems, which may not have symptoms, or may result in shortness of breath and

chest pain

Exams and Tests 

Because this disease has different forms, there is no specific test that can firmly diagnose it. Your doctor will perform a careful exam, which includes checking your heart sounds, skin, and joints.

Your doctor may also do an electrocardiogram while testing your heart.

You may have blood samples taken to test for recurrent strep infection (such as anASO test), complete blood counts, and sedimentation rate (ESR).

Several major and minor criteria have been developed to help standardize rheumatic fever diagnosis. Meeting these criteria, as well as having evidence of a recent streptococcal infection, can help confirm that you have rheumatic fever.

The major diagnostic criteria include:

Heart inflammation (carditis) Arthritis in several joints (polyarthritis) Nodules under the skin (subcutaneous skin nodules) Rapid, jerky movements (chorea, Sydenham's chorea) Skin rash (erythema marginatum)

The minor criteria include fever, joint pain, high ESR, and other laboratory findings.

You'll likely be diagnosed with rheumatic fever if you meet two major criteria, or one major and two minor criteria, and signs that you've had a previous strep infection.

Treatment   

Anti-inflammatory medications such as aspirin or corticosteroids reduce inflammation to help manage acute rheumatic fever.

People who test positive for strep throat should also be treated with antibiotics. You may have to take low doses of antibiotics (such as penicillin, sulfadiazine, or erythromycin) over the long term to prevent the disease from returning.

Outlook (Prognosis)    Rheumatic fever is likely to come back in people who don't take low-dose antibiotics continually, especially during the first 3 -5 years after the first episode of the disease. Heart complications may be severe, particularly if the heart valves are involved.

Possible Complications   

Damage to heart valves (in particular, mitral stenosis and aortic stenosis)

Endocarditis Heart failure Arrhythmias Pericarditis Sydenham's chorea

When to Contact a Medical Professional   

Call your health care provider if you develop symptoms of rheumatic fever. Because several other conditions have similar symptoms, you will need careful medical evaluation.

If you have symptoms of strep throat, tell your health care provider. You will need to be evaluated and treated if you do have strep throat, to decrease your risk of developing rheumatic fever.

Prevention   

The most important way to prevent rheumatic fever is by getting quick treatment for strep throat and scarlet fever.

Reye's syndrome

Reye's syndrome is a rare but serious disease that most often affects children 6 to 12 years old. It seems to be related to the use of aspirin to treat some viral illnesses, such as chickenpox. Reye's syndrome primarily targets the brain and liver. Brain swelling and chemical changes in the blood from liver damage affect the entire body. Drowsiness, confusion, seizures, coma, and in severe cases, death may result.

Reye's syndrome is a potentially fatal disease that causes numerous detrimental effects to many organs, especially the brain and liver. It is associated with aspirin consumption by children with viral diseases such as chickenpox.

The disease causes fatty liver with minimal inflammation, and severe encephalopathy (with swelling of the brain). The liver may become slightly enlarged and firm, and there is a change in the appearance of the kidneys. Jaundice is not usually present. Early diagnosis is vital, otherwise death or severe brain damage may follow

Causes of Reye's syndrome

The cause of Reye's syndrome is unknown. However, the disease most often develops in children who have recently had chickenpox (varicella) or flu (influenza) and who have also taken medications that contain aspirin. Reye's syndrome is not contagious.

The most important step you can take to prevent Reye's syndrome is to avoid giving aspirin or products that contain aspirin to anyone younger than 20 unless a health professional has specifically prescribed it.

symptoms

Often symptoms of Reye's syndrome appear during recovery from a viral infection, such as the flu or chickenpox, that has been treated with aspirin products. Symptoms usually develop 3 to 7 days after a viral illness starts. The symptoms develop rapidly over several hours to a day or two.

The first symptoms may include:

Sudden onset of retching or vomiting that is not clearly due to stomach flu. Sluggishness, lack of energy, and loss of interest in surroundings. Strange behavior, such as staring, irritability, personality change, and slurred speech. Drowsiness that may lead to severe sleepiness (stupor).

As brain damage progresses, other symptoms may develop, including:

Confusion and inability to identify whereabouts or family members or to answer simple questions (disorientation).

Rapid deep breathing (hyperventilation). Aggressive behavior, such as hitting others without reason (combativeness). Seizures and abnormal body positioning, and coma.

If Reye's syndrome is not recognized and treated promptly, death can occur.

How is Reye's syndrome diagnosed?

In general, a diagnosis of Reye's syndrome is considered if:

Your child has recently had a viral illness such as flu or chickenpox and has taken medication that contains aspirin.

A change in mental status (such as confusion) is noticed and liver problems are identified.

There is no evidence to suggest that symptoms are caused by other diseases or conditions, such as kidney failure or problems with metabolism.

Lab tests, if needed, include blood and urine tests, a liver biopsy, a CT scan of the head, and a lumbar puncture (spinal tap) to check for infection in the spinal fluid and to measure the pressure of the fluid within the spinal column.

Treatment

If your child has symptoms of Reye's syndrome, seek medical care immediately. Early treatment increases the chance for full recovery. If the disease is diagnosed early, most children recover from Reye's syndrome in a few weeks. However, some children develop permanent brain damage.

The goal of treatment is to stop damage to the brain and liver and to prevent complications. All children with Reye's syndrome are treated in a hospital intensive care unit.

Home treatment is not appropriate if your child has symptoms of Reye's syndrome. Seek medical care immediately, even if your child has not had a recent viral infection or taken aspirin. Early medical treatment lowers the risk of long-term complications and death.

You can help prevent Reye's syndrome. Because there is a strong link between the use of aspirin in children and the development of Reye's syndrome, do not give aspirin or products that contain aspirin to anyone younger than 20 unless directed by a health professional. This is especially important if the child has chickenpox (varicella) or the flu (influenza).

Aspirin is found in many nonprescription medicines. Read labels carefully before giving a nonprescription medicine to your child. Aspirin is also called:

Acetyl salicylate. Acetylsalicylic acid. Salicylic acid. Salicylate or subsalicylate.

Certain childhood illnesses, such as rheumatoid arthritis, may require aspirin as part of the treatment. However, give aspirin to a child only with direction from your health professional.

If your child is taking aspirin and gets chickenpox (varicella) or the flu (influenza), contact your health professional immediately.

The Nursing Care of the Child with Cardiovascular Disorder

Group Members:Balderas, Leiza E.

Azures, Joy Khristine H.

Coronado, AlyssaNazareno, Jimelda

Nocon, Kristen

III. Identification

__________1. An uncommon childhood illness that causes inflammation of the blood vessels.__________2. A drug that is considered to be a triggering factor for Reye’s syndrome__________3. A specific organism that is known to be a cause of rheumatic fever__________4. An acquired heart disorder condition in which the heart is not able to pump enough oxygen to meet the oxygen demand of the body __________5. A drug that causes brochodilation which is given to a child with a cardio pulmonary arrest.__________6. An Electronic device inserted inside the heart to control heartbeat by stimulating the ventricles electronically.__________7. Give one cardiac surgery complications__________8. open heart surgery is made possible by the use of ____ wherein the venous return of the heart is diverted from the right atrium to a heart lung machine to be artificially oxygenated._________9. site for cardiac catheterization for neonates__________10. a type of atrial septal defect which is located in the center of the atrial septum. An is most common type of atrial septal defect.

Enumeration.1. Common drugs helpful in resuscitation procedures that should be available on a pediatric emergency resuscitation cart include 1-3 2. Steps for resuscitation? .4-63. Example of acquired heart disease? 6-10