Airway Flashcards
What are the two other things that show on a FBC that we want to see
WBC
Platelets
Difference between Moderate and Severe WOB in infants
Moderate > grunting and recssions
Severe > can’t maintain sp02 despite 02 and ph change
Bradypnea + Tachypnea in the infant ranges
RR above 60
RR below 30
Pulse Oximetry screening
Specific heart lesions can be detected
e.g. hypoplatsic left heart syndrome , pulmonary atresia
need to be over 24 hours to screen
Acrocyanosis vs Central cyanosis
Acroc > blue colour of hands and feet
C Cyanosis - means that there is a desaturation of arterial blood secondary to resp and / or cardiac dysfunction
HB and cyanosis
Cyanosis can start to be seen when the HB is > 20 gm / dL or venous hematocrit of > 60%
sp02 would be above 85%
Retinopathy of prematurity
In term babes the retina is vascularised by the time the infant is born, however, in pre-term babes it is not.
> most common cause of blindness
To protect we must ensure the babe is limited in it’s exposure to oxygen and does not have an elevated P02 above 100 mmHg
Reasons babies can not be put on CPAP
Hernia
TEF / TEA
Chnonal atresia
Cleft palate
Cardio instability
“DOPE” - tube
Displaced
Obstruction
Pneumothorax
Equipment failure
Transient Tachypnea of the Newborn (TTNB)
Effects> term or late pre-term
Onset - 1-2 hours post birth
Cause - Failure to adequately absorb fetal lung fluid into the pulmonary circulation
Risk factors - c-section, precipitous delivery, pre-term labour
Signs - mild to mod resp distress. no 02 requirement above 40%
?Resolves - 2-3 days, sometimes 24 hours
Chest x-ray - fluid in fissures, pleural effusion
Respiratory distress syndrome (RDS)
Effects> pre-term or late pre-term
Onset - at birth or very shortly after
Cause - immature lung anatomy and surfactant insufficiency
Risk factors - GDM mothers (as they have a decreased surfactant production)
Signs - Resp. distress
Chest x-ray - diffuse granular appearance with air bronchograms and Low lung volumes
Pneumonia
Effects> term or pre-term
Onset - @ birth or with onset of infection
Chest x-ray - diffuse or focal infiltrates, hazy/opaque lung fields, lobar consolidation
Tracheosphagual fistula (TEF) or Esophageal Atresia (EA)
Effects> term or pre-term
TEF & EA are rarely found alone, usually both present
Signs - the onset of resp. distress at birth, the infant often has excessive salivation, choking, coughing and cyanosis with feeding
Congenital Diaphragmatic Hernia (CDH)
Effects> term or pre-term
Onset - Resp. distress at birth or very shortly after.
Signs - The infant will be cyanotic and decreased breath sounds on the side of the hernia (usually left). abdo sunken as intestine in chest
Treatment - Needs a tube , OG to remove air
Aspiration of amniotic fluid/blood or gastric contents
Effects> term or pre-term
Onset - at birth or time of aspiration
Evaluate hx to get clues
Chest x-ray - patchy infiltrates, areas of hyperinflation
Meconium Aspiration syndrome (MAS)
Effects> term or late pre-term
Cause - hypoxemic resp. failure, massive risk of sepsis
Poor placental blood flow and oxygenation causes the fetus to pass mec in utero.
Chest x-ray - shows coarse nodular opacities (mec in airways)
Pulmonary Hemorrhage
Effects> term or pre-term
Onset - sudden onset of cardioresp. distress and is accompanied by blood in the trachea
Blood filled alveoli and also inactivies sulfactant
What are the two obstructive airway conditions?
Chonal atresia
Pierre-Robin syndrome
Chonal atresia
Effects> term or pre-term
Cause - One or both of the posterior nasal passages are blocked by a boy septum or soft tissue membrane
Signs - cyanotic at rest but “pinks up” when crying because the infant breathes through its mouth
May need oral airway
Pierre Robin Syndrome
Effects> term or late pre-term
Cause -infants with a very small jaw with a normal size tongue that obstructs the airway (usually also have a cleft palate)
Turn infant prone, may need a NPA
Persistant pulmonary hypertensions of the newborn (PPHN)
Affects term infants
Elevated pulmonary resistance causes right to left shunting of blood across the PDA which leads to hypoxemia
Resp. distress and cyanosis are usually apparent within hours of birth
- NSIDs during preg can increase risk
Pneumothorax
Signs in newborns>
- Increased resp distress > cyanosis/tachypnea, nasal flaring, grunting, recessions
- acute onset or bradycardia or tachycardia
- irritability and restlessness
- hypotension
- VBG > Resp and /or metabolic acidosis
- positive tranillumition of the chest
