Internship Flashcards
Describe how to take apgar
score
APPEARANCE, PULSE, GRIMACE, ACTIVITY, RESPIRATION
Heart rate
O absent
1 < 100
2>100
Respiration
O absent
1 slow irregular
2 regular, crying
Muscle tone
O limp
1 some flexion of extremities
2 active movement
Response to stimulation
O no response
1 grimace
2 cough, sneeze, cry
Colour
O blue or pale
1 body pink, extremities blue
2 pink
Describe the newborn resuscitation algorithm (5)
Preterm, not breathing, poor tone
- Warm, dry and stimulate (unless < 30 weeks, wrap torso in plastic bag), clear airway if
necessary
Gasping, apnoeic (consider CPAP if ongoing respiratory distress) or hr < 100
- ventilate room air 30 - 40 breaths per minute, use oxygen it prem start at 30 - 40%
- Ventilate with supplemental oxygen as required
Hr < 60
- Continue ventilating with supplemental oxygen as required and consider intubation.
Start chest compressions.
- 0,1 - 0,3 ml/kg iv adrenaline (1:10 000), repeat every 3-5 mins
How determine corrected age?
Only do if baby born < 40 weeks gestation
Still < 40 weeks age: gestational age at birth (weeks) + age (weeks)
Eg baby born 28 weeks gestation and now 2
weeks old = 30 weeks corrected age
Born 28 weeks gestation and now 12 weeks
old = 40 weeks corrected age
More > 40 weeks age: 40 weeks + chronological age from DOB
Eg born 28 weeks gestation and now 14 weeks
old = 2 weeks corrected age
Born 28 weeks gestation and now 20 weeks
old = 8 weeks corrected age (48w on chart)
How tell if right atrium enlargement on CXR?
Ap: prominent r heart border
How tell if right ventricle enlargement on CXR?
Lateral: increased sternal contact > bottom 1/3
How tell if left atrium enlargement on CXR?
Ap: angle of carina >60 (splaying)
Lateral: prominent posterior bulge
Name and classify 7 types acyanotic congenital heart disease
Cardiac VAPE: coarctation, ASD, PDA, eisenmenger
Normal pulmonary blood flow (CAP)
RH:
- pulmonary stenosis (ejection systolic ULSB)
- (tricuspid incontinence) (common physiological, pulsatile liver if severe, pansystolic LLSB)
LH:
- aortic stenosis (ejection systolic RUSB)
- coarctation/interrupted aortic arch (continuous over back)
- (mitral incompetence) (congenital abnormal
MV or 2ndary to LH dilatation; pansystolic
арех)
Increased pulmonary blood flow (left to right shunts)
- patent ductus arteriosus (continuous ULSB)
- ventricular septal defect (pansystolic LLSB)
- atrio-ventricular septal defect (pansystolic from mitral (over apex)/tricuspid (LLSB)
regurg OR no murmur bc pressure balance quickly) - atrial septal defect (ejection systolic ULSB)
(eisenmenger syndrome)
Name and classify 9 types cyanotic congenital heart disease
5 Ts: TGA, TAPVD, truncus arteriosus, tetralogy, tricuspid atresia
Increased pulmonary blood flow (3 ts)
- transposition of the great arteries (ULSB
continuous due to PDA)
- total anomalous pulmonary venous drainage (ejection systolic ULSB due to PS and/or mid diastolic LLSB due to TS)
- Truncus arteriosus (pansystolic LLSB due to
VSD, or midsystolic)
- hypoplastic left heart syndrome (Eisenmenger syndrome)
Right to left shunts
Decreased pulmonary blood flow (PPETT)
(blockage RH to lungs)
- tetralogy of fallot (ejection systolic LUSB
due to PS)
- critical pulmonary stenosis (cont LUSB due
to PDA)
- Pulmonary valve atresia (cont LUSB due to
PDA)
- Ebstein anomaly (pansystolic LLSB due to
TR)
- tricuspid atresia (pansystolic LLSB due to
VSD)
Normal hr neonate <28 days? (EML)
110-160
100-165 themba
Normal hr 1mo-2 years? (EML)
100-150
Normal hr 2-5 years?
95-140
70-110 themba
Normal hr 5-12 years?
80-120
Normal respiratory rate neonate?
30-60
40-60 themba
Normal respiratory rate after neonate-2 years?
30-40(55)
Normal respiratory rate 2-5 years? (EML)
(20)25-30(40)
