Most emergency department procedures involve fear and apprehension, as well as pain in the preparation of wounds and fracture splint placement or reduction. Infants with uncorrected tetralogy of Fallot can have hypoxemic episodes when total oxygen demand during painful procedures exceeds that which the restricted pulmonary blood flow can support. Strain also increases the right-to-left shunt through a VSD, as well as the reduced pulmonary blood flow. As described previously, loss of consciousness can result. Pediatric consultation should be obtained, if at all possible, before attempting conscious sedation.
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