Clinical Reasoning and Newborn Exam I Flashcards
critical thinking
tying ones medical knowledge with clinical encounter
-and formulating a diagnosis with therapeutic strategy
steps in clinical reasoning
patient story data acquisition problem presentation hypothesis select a script for illness (acquire more data if need) diagnosis
signalment
who and what it is
-the patient identifying information
chief complaint
health issue of patient
history
what has happened
proper history
should give you diagnosis 80-90% of the time
miss more diagnosis
by not looking
-not doing good physical exam
ptyalism
excessive salivation
conformation bias
tendency to search for or interpret info in a way that confirms ones preconceptions
umbilical vein
carry oxygenated blood to the liver or IVC (via ductus venosus)
ductus venosus
allow oxygenated blood in umbilical vein to pass to the inferior vena cava
semi-oxygenated blood in right atrium
1- can go to right ventricle > to pulmonary artery -lungs have air sacs full of fluid -hypoxic pulmonary vasoconstriction -increased resistance -high pressure to lungs -less likely to flow this way -also high P in right heart -higher than P in left atrium
2- blood flows foramen ovale - right atrium to left atrium
- blood to left ventricle
- then to aorta
- distributes to body
foramen ovale
allows blood from right atrium to left atrium
lung blood flow before birth
high resistance
ductus arteriosus
connection between pulmonary artery and aorta
- allows blood from pulmonary artery to aorta
- this direction because high lung R
internal iliac arteries
branches to umbilical artery (2x)
- brings deoxygenated blood to placenta
- placenta has low R so blood is directed here
after birth changes
- placenta removed
- lung bring in air
cause lots of changes
placenta removed
whartons jelly contraction
- natural clamp
- to very high R
whartons jelly
contracts around vessels as temperature falls
lung changes
fluid replaced by air
- oxygen levels rise
- stops the hypoxic pulmoanry vasoconstriction
- results in dilation
- causes decreased R in lungs
- right heart pressure falls
- oxygenated blood to left atrium
- increases pressure in left side of heart
- causes close of foramen ovale (first few minutes)
ductus arteriosus changes
- first few hours of life
- constriction of ductus arteriousus
- sense high oxygen levels
- also senses placenta removed - prostaglandin decrease
umbilical artery changes
high resistance
- no blood that way
- have smooth muscle that contracts
over course of few hours
umbilical vein changes
no blood flow after placenta removed
-blood clots off
ductus venosus changes
no blood flow after placenta removed
-blood clots off
