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Paediatricians play an integral role in the lifelong care of children with CHD, many of whom will undergo cardiac surgery. There is a paucity of literature for the paediatrician regarding the post-operative care of such patients.
The aim of this manuscript is to summarise essential principles and pertinent lesion-specific context for the care of patients who have undergone surgery or intervention resulting in a biventricular circulation.
Familiarity with common issues following cardiac surgery or intervention, as well as key details regarding specific lesions and surgeries, will aid the paediatrician in providing optimal care for these patients.
Single ventricle CHD affects about 5 out of 100,000 newborns, resulting in complex anatomy often requiring multiple, staged palliative surgeries. Paediatricians are an essential part of the team that cares for children with single ventricle CHD. These patients often encounter their paediatrician first when a complication arises, so it is critical to ensure the paediatrician is knowledgeable of these issues to provide optimal care.
We reviewed the subtypes of single ventricle heart disease and the various palliative surgeries these patients undergo. We then searched the literature to detail the general paediatrician’s approach to single ventricle patients at different stages of surgical palliation.
Single ventricle patients undergo staged palliation that drastically changes physiology after each intervention. Coordinated care between their paediatrician and cardiologist is requisite to provide excellent care. This review highlights what to expect when these patients are seen by their paediatrician for either well child visits or additional visits for parental or patient concern.
This article analyzes the constitutional problems of “first use” of nuclear weapons. Its organizing principle is that Congress has a constitutional duty to ensure such control over nuclear weapons that first use (and first strike) is proscribed. After demonstrating that the Constitution requires collective decisionmaking in important policy decisions, it is recommended that Congress retrieve its delegated power over nuclear weaponry, and also establish a “council of state” within the office of the presidency with which the president must consult before taking important decisions, including those involving nuclear warfare. The council would take a sober “first look” at proposed policies, but the ultimate responsibility would be the president's.
This article analyzes the constitutional problems involved in “first use” of nuclear weapons. Its organizing principle is that Congress has a constitutional duty to ensure such control over nuclear weapons that first use (and first strike) is proscribed. After demonstrating that the Constitution requires collective decision-making in important policy decisions, it is recommended that Congress retrieve its delegated power over nuclear weaponry, and also establish a “council of state” within the office of the presidency with which the president must consult before taking important decisions, including those involving nuclear warfare. The council would take a sober “first look” at proposed policies, but the ultimate responsibility would be the president's.