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S.T.A.B.L.E. – Cardiac Module: Recognition and Stabilization of neonates with severe CHD. By Kristine A. Karlsen, PhD, NNP-BC with cardiology technical advisor Lloyd Y. Tani MD (2003). 1st place winner in the 2004 American Medical Writers Association Book Competition!

The S.T.A.B.L.E. – Cardiac Module provides general guidelines for the assessment and stabilization of neonates with suspected congenital heart disease (CHD). Prompt, effective, and appropriate care of neonates with severe CHD can reduce secondary organ damage, improve short and long-term outcomes, and reduce morbidity and mortality. This information is presented in a highly visual format and divided into three sections. The first section of the module reviews the physical exam of neonates with suspected CHD. The second section details the anatomic features, clinical presentation and initial stabilization of neonates with CHD, and emphasizes differentiation of cardiac from pulmonary disease. Specific heart lesions are covered in detail including those that are cyanotic ductal dependent, cyanotic not-ductal dependent, and left outflow tract obstructed ductal dependent lesions. The final section discusses modifications to the six S.T.A.B.L.E. assessment components that are necessary when caring for neonates with suspected or confirmed CHD.

PART ONE

1. Physical examination and patient assessment for CHD (includes treatment of SVT, assessment of heart sounds and murmurs);
2. Differential diagnosis for CHD.

PART TWO

1. Cyanotic CHD – Not ductal dependent Tetralogy of Fallot* Truncus arteriosus Total anomalous pulmonary venous return (TAPVR) Ebstein’s anomaly* *Extreme forms may be ductal dependent

2. Cyanotic CHD – ductal dependent for pulmonary blood flow The ductus arteriosus – right-to-left and left-to-right shunting Prostaglandin E1 – Indications, Dose, Side Effects, Administration Guidelines Transposition of the great arteries (TGA) Tricuspid atresia Pulmonary atresia (w/intact ventricular septum) Tetralogy with severe PS or atresia Severe Ebstein’s

3. Left Outflow Tract Obstructive Lesions – ductal-dependent for systemic blood flow Coarctation of the aorta Critical aortic stenosis Interrupted aortic arch Hypoplastic left heart syndrome

PART THREE

Sugar – Temperature – Airway – Blood Pressure – Lab Work – Emotional Support Mnemonic-based assessment and care of neonates with suspected or confirmed severe CHD.

Q: Who should take this module? A: Any neonatal or pediatric healthcare provider (physicians, nurses, respiratory therapists) who must identify and care for neonates or infants with congenital heart disease.

Q: Should the S.T.A.B.L.E. Learner course be taken first? A: Although it is recommended that students take the learner course prior to this module, it is not mandatory. We recognize that many pediatric healthcare providers may not have participated in the S.T.A.B.L.E. learner program, yet our expert reviewers felt the Cardiac module would still be very valuable for those caregivers.

Q: How is the module presented? A: As with the S.T.A.B.L.E. Learner course, it is recommended that an expert in neonatal or pediatric (cardiac) care present this material. An animated CD-ROM guides the instructor through the material, while the 125-page full-color manual serves as the student handbook. Some of the material overlaps with the S.T.A.B.L.E. learner course, therefore, it may be best to wait a few months before teaching the cardiac module. This module is not intended for “same day” presentation with the S.T.A.B.L.E. Learner course. There are no pre or post-tests for the Cardiac Module course.

Q: How long does it take to teach the module? A: This didactic/interactive module is presented in 4 to 8 hours, depending on the student’s expertise. If given in 4 hours (excluding breaks), allow 1 hour for the Part 1 – Physical Exam; 2 to 2.5 hours for Part 2 – CHD lesions; and 0.5 to 1 hour for Part 3 – S.T.A.B.L.E. modifications. It is strongly recommended that students read the manual prior to the course.

Q: Do I need to attend a S.T.A.B.L.E.-Sponsored Cardiac Module presentation in order to teach this module? A: No. The most important consideration is that you are an expert in this area. If you are comfortable with teaching concepts of neonatal congenital heart disease, this module should be relatively easy for you to teach. There is no instructor manual for this module.

Upon registering for the Instructor course, all Instructor candidates will be emailed a pre-assessment which is intended to be taken closed-book and without the assistance of another colleague or resources. This pre-assessment should be viewed as the Instructor Candidate’s opportunity to identify their own knowledge strengths and potential weaknesses. Upon arrival at the Instructor course, candidates will have an opportunity to self-grade their own test. Or, if preferred, the pre-assessment can be scored before the course by the S.T.A.B.L.E. Program staff. Instructions will be supplied when the pre-test is emailed regarding how to submit the pre-assessment for scoring.

Please note the following about the pre-assessment scores and eligibility to register as an Instructor:

1. The average score for Instructor candidates is 85% and higher (6 or fewer wrong on the pre-assessment).
2. If you score below 70% (greater than 12 wrong), you are scoring well below the average for Instructor candidates and we cannot register you as an Instructor. If you decide to attend the Instructor course anyway, we are happy to award you with a Learner course completion card upon successful completion of the mixed module test.
3. Grading of Pre-Assessment: If you would like your test graded ahead of the Instructor course, then you may email or FAX it to our Instructor Course Coordinator, Mason Meinhold. Please call the office for details and to request Mason’s email address: 1-435-655-8171 or go to our Contact Us tab and send an inquiry.
4. Refunds: Please note, no refunds will be provided to those who either do not qualify for the Lead or Support Instructor role, or who are not eligible to be registered as an Instructor because of low pre-test scores as outlined above.

Instructor Course attendees please join us for a dinner on May 1, hosted by Clinical Innovations, Inc. to learn about: Reducing the Risks of Vacuum-Assisted Deliveries—A Practical Approach

As S.T.A.B.L.E. Program Instructors, you will have many Labor/Delivery/Postpartum staff in your classes. There is so much to learn about the topic of safe Vacuum Assist Delivery and this dinner will be an excellent opportunity to learn and ask questions and speak with Dr. McQuivey. This is a non-CEU/CME offering. Please sign up during the on-line registration process for the S.T.A.B.L.E. Instructor course. Dinner starts at 6 pm in the Douglas Ballroom.