Emergency management of hypercyanotic crises in tetralogy of Fallot

We report the case of a 3-month-old girl with tetralogy of Fallot who was resuscitated from a near-fatal hypercyanotic episode (Tet spell). While tetralogy of Fallot is rare (1 in 10,000 live births), failures of diagnosis or management may result in catastrophic outcomes for an eminently survivable condition. An understanding of the pathophysiology of hypercyanotic spells will allow the emergency specialist to understand and apply a treatment option--compression of the abdominal aorta--not previously reported in the emergency medicine literature.