Disease Processes Flashcards by Ian garcia

What is Respiratory Distress Syndrome or Hyaline Membrane Disease and what is its Pathophysiology?

Def: Surfactant deficiency of the lung causing decreased lung compliance and atelectasis

Patho:
-Collapse of the alveoli after each breath
-Plasma leaks out of the lung tissue
-Forms a hyaline membrane
Lack of surfactant-Alveolar Collapse
Increased Pressures needed-leads to vasoconstriction, acidosis, hypoxemia
Capillary endothelial damage with fluid leaking into alveolar space
Diffusion of O2 and CO2 difficult due to decreased pulmonary blood flow and atelectasis
Over inflation further damages Type II cells
Formation of hyaline membrane

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Who are the infants at risk of RDS?

Premature infants

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How can we detect RDS?

L/S ratio 2:1
PG+
Shake Test (Foam Stability Index>48) i

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What are the clinical signs of RDS?

10 possible signs

Intercostal retractions
Expiratory Grunting
Nasal Flaring
Tachypnea
Apnea
Decreased BS
Cyanosis
Metabolic and/or Respiratory Acidosis
Poor Peripheral Perfusion
Hypotension/shock

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How can we treat RDS?

Oxygen Therapy
Nasal CPAP
Steroids
Exogenous Surfactant
Ventilatory Support--HFOV vs Conventional Vent
Pulse Ox/TCM

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How can we manage RDS?

Surfactant Replacement Therapy (Prophylactic or Rescue)

Prophylactic:
.30 FiO2 to maintain PaO2>50 or O2 sat>90%
-CXR consistent with RDS

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What are the Management Strategies for RDS?

What is the Main objective for these management strategies?

*Lung Protective strategies
Gentle suctioning prn
Minimal handling--cluster care
Fluid and electrolyte balance-keep on the dry side
Maintain blood glucose 45-120 mg%
Amp and Gent antibiotics

To do whatever I can do to avoid the use of Positive pressure ventilation.

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What is PPHN?

Failure of shunts to close during transition from fetal circulation due to lack of O2

High PVR causing RightHe to Left shunt

Hypoxemia and acidemia causes further PVR and perpetuates the cycle

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What are the clinical signs of PPHN?

6 signs

Severe Respiratory Distress

Cyanosis

Hypoxemia on 100% O2 with positive pressure

unexplained by degree of lung disease

CXR shows ¯Vascular Markings and enlarged heart

Breath sounds—rales

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What 2 conditions need to Ruled out or diagnosed in the presence of PPHN?

Severe causing RDS
congenital Heart Defect

in general, just becuase you caught PPHN doesnt mean that that is the only thing wrong. could be PNA, diaphragmatic hernia, etc.

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What is the true test for R-L shunt in PPHN?

What are some secondary tests? (3)

Contrast echocardiography used to confirm shunting

Ductal blood gas, 02 hyperoxia challenge (100% for 20 mins, hyper ventilation test)

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What is the treatment for PPHN?

Prevent hypoxemia, acidosis and hypothermia

Correct hypoxemia by reversing R>L shunting

Drug Therapy [(INO, oxygen, Priscoline (tolazoline)] - drugs to reduce PVR

PPV with 100% Oxygen

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What is the Vent strategy for PPHN?

High rate with short I-time. use just enough to move the chest

With a goal to Reduce PaCO2 to a level where PaO2 rises above 100mmHg.

Use enough FiO2 to keep PaO2 > 120mmHg if possible

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What 3 drugs are used to treat PPHN?

What is the main objective of these drugs and its goal?

iNO, oxygen, Priscoline (tolazoline)

they are drugs to reduce PVR with the goal of closing the Patent ductus arteriosis

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What is the most recognized site of infection in new borns within the first 24 hours of life?

Lungs

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What are the sources of PNA?

intrapartum

Aspiration in utero
Aspiration during delivery

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What are contributing factors to PNA?

premature rupture of the membrane (can introduce bacteria too soon)
Prolonged labor
Excessive obstrectric manipulation
Maternal GI infection
Infection (GBS, ecoli, herpes, listeria)

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What are signs and symptoms of PNA?

5 signs and symptoms

MOM says Baby doesn’t “look” right/“Not acting right”
Rapid Respiratory deterioration
Apnea and/or bradycardia Especially 
Temp instability
hypotension/poor perfusion

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What does temperature instability appear like for term and preterm babies with PNA?

Term—hyperthermia

Preterm-– hypothermia

What are the treatment options for PNA?

Careful assessment and monitoring
Antibiotic Therapy
Fluid/Electrolyte support
Blood Products/volume replacement
Respiratory Support as needed

What do you watch out for in babies with PNA?

Watch out for septic shock!

What are risk factors for Merconium aspiration?

Prolonged gestation >42 weeks

SGA

IUGR

Placental insufficiency (hypertension, Preeclampsia, Previa, Abruption)

Intrapartum asphyxia (Cord prolapse or Prolonged labor)

What causes Merconium Aspiration?

Fetal asphyxia to intestinal hypoxia then to hyperperiastalsis then anal sphincter relaxation causes merconium to enter the amniotic fluid.

this can happen before or after delivery

How can merconium aspiration happen after delivery?

baby can swallow the merconium during delivery cause a reflux and aspirate it into the lungs

What are some clinical signs of merconium aspiration?

``` Tachypnea with intercostal retractions Cyanosis, grunting, flaring Increased AP thoracic diameter Coarse bronchial breath sounds Airway obstruction/Air Trapping Complete (atelectasis) Incomplete (ball – valve action blocking airway from exhalation) Alert, anxious LOOK ```

What are treatment options for Merconium Aspiration?

Lung protection strategy MOST IMPT, Do not stimulate to breathe.

When do you follow merconium protocols after the baby is born with suspected merconium aspiration?

If the baby is non-vigorous and flacid use merconium protocols If the baby is vigorous and crying on their own, just treat the PNA

What do you do in merconium protocols? | 3 things

intubate at first breath Direct tracheal suction below cords with DeLee suction which connects directly and uses ET tube for suction. PPV HFOV is recommended If conventional, high pressures with short i-times Hyperoxygenate with hypocapnea, Alkalosis

What is the Vent strategy for RDS?

.30 FiO2 | maintain PaO2>50 or O2 sat>90%

What does a CXR from RDS look like?

Uniform reticulogranular appearance AKA ground glass Low lung volumes Air Bronchograms Atelectasis

What does a CXR from PNA in infants look like? | 2 things

Diffuse Bilateral infiltrates patchy infiltrate in perihilar area

What is TTHN?

Failure of fetal lung fluid to clear causing respiratory distress

What are signs and symptoms of TTHN?

``` Minics clinical early RDS Tachypnea resulting in hyperventilation Mild respiratory alkalemia Cyanosis Barrel – shaped chest Retracitons/grunting Nasal Flaring ```

What does TTHN in CXR look like?

Wet LUNG Perihilar congestion There may be small collections of liquid at the costophrenic angles Progressive clearing within 48-72 hours

What is the treatment for TTHN?

Supplemental Oxygen 100% by Head Hood High flow nasal oxygen (vapotherm) NCPAP 4 – 6 cwp 100% O2

What is PIE or air leaks?

``` Pulmonary Diseases Stiff non compliant lungs Aspriation syndromes Hypoplastic lungs Congenital lobar or pulmonary interstitial emphysema ``` Positive pressure ventilation

What are some prevention strategies for PIE?

``` HFV Permissive Hypercapnea Keep airways clear Pressure gauges Recognition of infants at risk ```

what are some signs and symptoms of PIE?

``` Restless Irritable Lethargy Tachypnea Increased respiratory effort profound general cyanosis Bradycardia Decreased of shifted breath sounds Chest asymmetry Severe hypotension and poor peripheral perfusion Cardiac arrest ```

What are conformations of PIE/Air leaks?

Transilumination of the Chest | CXR

What are treatment options for PIE?

Needle aspiration 2nd intercostal space midclavicular line Oxygen therapy HFV

What is BPD?

A Chronic lung condition that starts with severe RDS. has 4 stages Presents it self in Infants requiring high ventilator settings with high FiO2 after 10 days

What is the treatment for BPD?

Use lowest ventilatory support and FiO2 to permit lung to heal. Titrate Fi02 keeping sats 88 – 92 HFOV recommended in early stages of RDS to prevent BPD. Good nutrition to support lung growth Treat infections

What is Chornal atresia and how do you check for it?

Formation of bone that blocks ventilation through the nasal passage. Babies are obligate nose breathers. they can only breathe through crying. conformation with size 6 french catheter's inability to pass through nose.

What is esophageal atresia?

it is a birth defect wherein the esophagus is narrow or absence of connection to stomach.

What is the most common esophageal atresia?

Esophageal atresia with distal transesophegeal Fistula.

What are some clinical signs and symptoms of TEF and EA?

Inability of pass OG tube (This is Very impt Point) Excessive drooling due to inability to swallow Aspiration of gastric secretions Choking/coughing with first feeding Episodes of cyanosis

In RDS, what would show up on a CXR?

Air bronchograms Ground glass