congenital heart disease

A 3-month-old male is brought in for increased work of breathing for the last 4 days. The patient has had no fevers or sick contacts. He was born full term without complications, is fully vaccinated, and has no familial medical history. Triage vital signs (VS): BP 85/50, HR 152, RR 56, SpO2 92% on room air, oral temp 99.9. The patient is tachypneic with weak cry, but has normal pink color. There is a 4/6 holosystolic murmur, with 2+ femoral and brachial pulses. He has suprasternal and intercostal retractions with wheezes. There is also palpable hepatomegaly. What are your next steps?

A 3-day full term male presents with poor feeding and lethargy, looking grey. He is diaphoretic with feeds. He has not gained weight since birth. He is afebrile, tachycardic, tachypneic, grey appearing, with cool extremities and poor capillary refill. What should you consider?

A 6-day-old male presents with increased work of breathing for last 4 hours and an episode of turning blue, which concerned the family. The baby is lethargic, afebrile, and cyanotic, with a weak cry to stimulation. There is a sunken fontanelle, perioral cyanosis with purple intra-oral mucosa, and blue tongue. He is tachypneic and has mild retractions, clear lung sounds, and dullness to percussion 4 cm past right costal margin. There is poor tone and mottled extremities. What should you consider?