Tet Spell Tilda — Tetralogy of Fallot: The Blue Spell and the Squat That Saves It
Four defects, one blue spell — and the child squats to fix her own circulation
When Tilda turns blue, she drops into a squat — her own body knows how to squeeze blood back toward her lungs.
Tilda turns blue when she plays. Tetralogy of Fallot is a cyanotic heart defect with four parts: a ventricular septal defect, pulmonary stenosis, an overriding aorta and right ventricular hypertrophy. Pulmonary stenosis limits blood flow to the lungs, so deoxygenated blood slips through the VSD into the body. Crying, feeding or exertion can trigger a hypercyanotic tet spell — sudden deep blue color, rapid breathing and irritability as oxygen plummets. Older children instinctively squat, which increases pressure on the left side of the heart and pushes blood back toward the lungs. During a spell the nurse places the infant in the knee-chest position, gives oxygen, keeps the child calm and prepares morphine as ordered.
Read Tet Spell Tilda's full story →The story arc
The setup
A newborn has a loud murmur and clubbing is noted months later; she tires easily with feeds.
The turn
Her mother notices that whenever she gets upset, she squats down and her color improves.
The crisis
During a crying fit she becomes deeply blue, breathes rapidly and goes limp.
The save
Tilda is placed in knee-chest position, oxygen is given, and she calms as her color returns.
NCLEX study section — Tetralogy of Fallot: The Blue Spell and the Squat That Saves It
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Pediatrics
Take this chapter into practice questions on the same topic.