Final Flashcards
Chest X-Ray
Croup vs. Epiglottitis
Croup- Steeple Sign; Subglottic narrowing lower in the airway. Linear narrowing of trachea (wedge shaped)
Epiglottitis- Thumb Sign; Swollen epiglottis higher in the airway
Bronchiectasis
Irreversible dilation and disortion of bronchial tree
Result of airway obstruction, chronic infection, and extensive inflammation
Dilation due to destruction of bronchial cartilage elastic fibres, blood vessels and smooth muscle
Congenital condition in a small number of patients
Bronchiectasis and Secretions
Leads to insufficient airway secretion clerance due to inadequate ciliary activity
Poro bronchial toliet will increase the risk of infection
Croup Treatment
Supportive Care-Humidity, Oxygen, Corticosteroids, Dexamethasone, Recemic Epinephrine (1:1000 mg- 5 ml)
Try to have minimal diagnositic and handling
May lead to intubation if obstruction become serious
Other Name for Croup
Laryngotracheobronchitis
Croup Clinical Manifestation
Barking, seal like cough
Hoarse voice and stridor
Low to moderate fever and dehydration
Pediatric Signs of Impending Respiratory Failure
Increased work of breathing at rest with intercostal and substernal retractions
Increasing O2 requirements and lethargy are signs of impending respiratory failure
Epiglottitis Pathophysiology
Acute bacterial infection
Inflammation of supraglottic structure producing an enlagred cherry red epiglottis which can partially or completely obstruct airway
Age on onset: < 6 years of age
Primary Cause of Epiglottitis
Haemophilusinfluenzae Type B
Rarer due to vaccinations*: 95% reduction in cases
Non-Infectious Causes of Epiglottitis
Aspiration of hot liquid
Multiple intubations
Pathology of Foreign Body Aspiration
Distal areas will become atelectatic and increased shunt
Can lead to infection
What are the 2 types of congenital diaphragmatic hernia
-
Bochdalek Hernia
- Lateral and posterior defect
- Usually will occur in the left hemidiaphragm
- Most common
- Occurs 90% of the time
-
Morgagni Hernia
- Medial and anterior
- Occurs on both sides
- Liver will prevent some up the upwards movement
Congenital Diaphragmatic Hernia
Pathophysiology
Lung Hypoplasia because it does not have enough room to properly develop
Decreased pulmonary vasculature (Pulmonary hypertension and decreased alveolar count)
Congenital Diaphragmatic Hernia
Chest X Ray
Loop and air in the thoracic cavity
Mediastinum will be pushed to the right
Congenital Diaphragmatic Hernia
Clinical Manifestations
- Significant respiratory distress at birth with severe hypoxia and acidosis
- Scaphoid Abdomen (Depressed Triagular shape)
- Barrel Chest
- Heart displaced to the opposite side of the hernia
- Increased PVR with a persistent shunt
- Worsening right to left shunt
Angioplasty
Can be done at the same time as a angiography if needed
A catheter will be floated through the artery and then the balloon is repeated inflated and deflated to flatten the plauqe againt the artery wall
If this is the only treament given then renstenosis may be needed later on
Coronary Artery Disease
Coronary Angiography
Gold standard for diagnosis CAD will evaluate the extent and location of blockages
Only test that indicate which treatment to use
A catheter is inserted into an artery (usually femoral) which is threaded up into coronary artery
Dye is injected at this point and fluoroscopy captures the image of the blood flow
B Blockers
HR and contraction of the heart will decrease = Decrease BP
Will block the effects of epinephrine causing vasodilation
These drugs will end in -olol
Not used for people with asthma
ACE Inhibitor
Will inhibit ACE enzyme = decrease production of angiotensin II
As a result, blood vessels enlarge or dilate, and blood pressure is reduced.
Ends in -pril
Coronary Artery Disease
Stenting
Will commonly be done at same time as angiography
The goal is to help prevent restenosis, or at least lengthen the time before restenosis occurs
Use of drug-impregnated stents reduces risk of restenosis.
What Are Most Myocardial Infarctions Caused by
Most MI’s are caused through a ruptured atherosclerotic plaque
The risk factors for the development of CAD are also risk factors for an MI
Myocardial Infarction
Pathophysiology
Myocardium is deprived of oxygen which leads to ischemia ► Areas of Injury ►Infarction
Reperfusion injury is also an important component of the pathophysiology.
Myocardial Area of Injury
An area of injury can repair itself but 100% as there is extra fibrinogen, fat deposits, etc
Area of Infarction
Transmural
Full thickness of myocardium
Area of Infarction
Subendocardial
Partial thickness of myocardium
Myocardial Infarction
Blood Markers-Myoglobin
Very sensitive and early marker of myocardial necrosis, but is not specific for MI
Levels will begin to rise within 1 hour with peaks within 4-8 hours
Will return to normal by 36 hours
Myocardial Infarction
Blood Markers Troponin I
1 test of choice
Marker of damaged tissue after an MI
Detectable at 3-6 hours and peaks at 26 hours
Remains elevated for 14 days
Highly sensitive test
Myocardial Infarction
ECG-ST Segments
Depression (ischemia)
Elevation (infarction)
ST segment elevation is only considered pathologic if it occurs in two or more anatomically contiguous leads!
Meconium Aspiration Syndrome (MAS)
Anatomic Alterations of the Lungs
Meconium can either fully or partially obstruct the airway and create a ball-valve effect - meaning that the air can enter the alveoli but not readily leave
Chemical Pneumonitis
Decreased Surfactant=RDS
Hypoxia-induced vasoconstriction and vasospasm. The vasospasm can pulmonary hypertension - right to left shunt
Myocardial Infarction
Time Frames
- 0-30 Minutes
- Reversible injury
- 1-2 Hours
- Onset of irreversible injury
- 4-12 Hours
- Beginning of necrosis
How long does necrosis and scar tissue development after MI occur for
There will continue to be necrosis and development of scar tissues occurs up until 8th week post infarct
The risk for myocardial rupture is greatest at days 4-7 post infarct
As the tougher fibrotic scar tissue starts to form 7-10 days post infarct
Myocardial Infarction
Blood Markers Total CK
Enzyme of cardiac damage
Vessels Commonly Used for CABG
saphenous vein, internal mammary artery or radial artery
Myocardial Infarction
Blood Markers CK-MB
Levels will begin to rise within 4 hours and peak at 24 hours
Levels will subside by 3 days
Not specific to MI
Reperfusion therapy
Reperfusion therapy is a medical treatment to restore blood flow, either through or around, blocked arteries, typically after a MI
The goal is to reduce mortality and limit the infarct size
Methods for Reperfusion Therapy
- Thrombolytics
- Dissolve blood and platelet clots
- Best is used within 60-90 minutes of onset
- Should be given by EMT
- Risk of bleeding must be considered, because you will have a time period when there is no clotting factors avalible
- Percutaneous Coronary Interventions (PCI)
- CABG
Cor Pulmonale
Enlargement and failure of right ventircle due to increase resistance from lungs
Chronic pulmonary heart disease will usually result in right ventricular hypertrophy
Left Sided Heart Failure
The left side of the heart is unable to properly pump blood=low systemic perfusion
Low systemic perfusion will then lead to vasoconstriction (increased SVR)
Blood may back into pulmonary system ►pulmonary congestion and right sided heart failure
When the RH fails there is a decreased pulmonary congestion giving a false look of improvement
Right Sided Heart Failure
Hemodynamic Profile
- Increased
- CVP
Left Sided Heart Failure
Hemodynamics
- Increased
- PAWP
- HR
- Decreased
- CO
- Pulse pressure
Right Sided Heart Failure
Forward Failure
Decreased RV output leading to venous congestion
Right Sided Heart Failure
Backwards Failure
Decrease RV output -> Decreased pulmonary perfusion ->Decreased LV filling ->Decreased LV output -> systemic perfusion
Myocardial Infarction
12 Leads and Coronary Arteries-Anterior Injury
V3, V4
Myocardial Infarction
12 Leads and Coronary Arteries-Septal Injury
V1, V2
Pulmonary Interstitial Emphysema (PIE)
Pathophysiology
The small airway rupture will compress the vasculature leading to decreased pulmonary perfusion, increase PVR, and incresae R-L shunt
There will be an increased airway resistance due to the decrease in the lumen of the bronchioles
Neonatal Jaundice
Occurs in 50% normal births
Can occur due to delayed feeding, hemolytic disease, liver/gut defects.
Kernicterus
Severe hyperbilirubinemia
Will toxifie the baby and lead to CNS impairment, seizures, and motor dsyfunction
Treatment for Jaundice
Phototherapy (blue light) helps to form conjugated bilirubin to allow excretion, and exchange transfusion.
Necrotizing Enterocolitis (NEC)
Inflammatory destructive bowel disease that is charaterized by necrosis of colon and ileum caused by intestinal ischemia
Necrosis will cause abdominal distension, sepsis, hypoxemia, respiratory failure, intestinal perforation
Gangrene can also occur
Related to asphyxia in utero
Periventricular Leukomalacia (PVL)
Pathophysiology
Occurs in the white matter adjacent to the lateral ventricles
Injury occurs in response to hypotension, ischemia, and necrosis due to asphyxia.
Can also results from increased fluid or hemorrhage compressing arterioles in the white matter.
IVH- Intraventricular Hemorrhage
Pathophysiology
Bleeding starts in the germinal matrix (a highly vascular network that matures and gets smaller with gestational age)
Blood fills the ventricles and compresses brain parenchyma
Any factor that increases or decreases cerebral blood flow will cause rupture
Acute epiglottitis Vs Laryngotracheobronchitis(croup)
Cause
Croup- Viral (parainfluenza, RSV)
Epiglottis-Bacterial (harmophilius influenze type B)
Bronchiolitis
Inflammatory disease of the bronchioles
Most common lower respiratory infection in pediatrics
Most common cause: RSV (Respiratory Syncytial Virus)
Sweat Chloride Test
Infants Six Months or Younger
≤29 mmol/L: Normal (CF very unlikely)
30 to 59 mmol/L: Intermediate (Possible CF)
≥60 mmol/L: Abnormal (CF Diagnosis)
Sweat Chloride Test
Infants Older than Six Months, Children and Adults
≤39 mmol/L: Normal (CF very unlikely)
40 to 59 mmol/L: Intermediate (Possible CF)
≥60 mmol/L: Abnormal (CF Diagnosis)
Sleep Apnea
Cessation of bretahing for 10 sec or longer until the brain over comes the problem
Sleep apnea is diagnosed when there is more than 5 apneas per hour occurring over a 6 hour period
How Do Third Degree Burns Heal
The resultant damage heals with hypertrophic scars (keloids) and chronic granulation
