Ken's Final Flashcards
What are the four questions?
Is the baby term?
Is the amniotic fluid clear?
Is the baby breathing effectively?
Does the baby have good muscle tone?
What four things should you be prepared to do when receiving a newborn?
Be prepared to
- Keep baby warm
- Provide blended oxygen
- Provide nasal CPAP
- Deliver exogenous surfactant
How do you figure out what size ET tube to use on a baby?
- <1000 grams = 2.5
- 1000-2000 grams = 3.0
- 2000-3000 grams =3.5
- 3000 grams = 3.5 to 4.0
What ventilator breath type should you use on a neonate?
What breath type should you never use?
SIMV with TCPL or PC.
Never use volume control.
How much tidal volume should you aim for when ventilating a newborn?
4-7 ml.kg.
What is the vent setting basic recipe?
20/5 x40 at 40%
PRDS CXR appearance: \_\_\_\_, ground \_\_\_\_ appearance \_\_\_\_\_ and \_\_\_\_\_ Air \_\_\_\_\_\_\_\_\_ No \_\_\_\_\_ \_\_\_\_\_\_\_
Bilateral ground glass appearance
Atelectasis -> volume loss
Air bronchograms
No pleural effusions
Neonatal lungs should be inflated to ___.
T9 with rounded diaphragms
A newborn will be predisposed to PRDS if the mother is younger than ___ or older than ___ or if the mother smokes _____ or _____
Younger than 16
Older than 35
Smokes tobacco or crack. (Drug abuse)
These two kinds of deliveries will predispose a baby to PRDS.
C-section
Multiple births
Neonatal acidosis can reduce/impair these three things.
Also it will increase this:
Reduced myocardial contractility
Abnormal brain function
Decreased surfactant
Increased pulmonary vascular resistance
What's the treatment for PIE? Gentile \_\_\_\_ and use of \_\_\_\_ \_\_ \_\_ as necessary Place the affected side \_\_\_\_\_\_ Consider single \_\_\_\_\_ \_\_\_\_\_\_ and \_\_\_\_\_\_ \_\_\_\_\_\_
Gentile ventilation with PHY Chest tubes as necessary Affected side down Single lung ventilation Mainstem intubation
What do you do to decrease PaCO2 in Jet PIP?
Adjust upward
What do you do to decrease PaCO2 in Jet rate?
Adjust downward
What three things determine PaO2 in HFJV?
CV FiO2
CV PEEP
CV Sigh rate
In HFOV, how do you decrease PaCO2?
Turn up Delta P (aka Power/Amplitude)
Decrease the frequency (aka hertz)
Treatment for CDH: Don't \_\_\_\_ these pt's. \_\_ immediately. Have a \_\_ \_\_ \_\_ \_\_ placed. The pt needs \_\_\_\_\_
Don’t bag these pt’s.
Intubate immediately and have double lumen gastric tube placed.
Needs surgery
Ventilation concerns for CDH:
Anticipate __due to __ __.
__ is preferred but __ __ is OK
Anticipate pulmonary HTN due to refractory hypoxemia
HFOV is preferred but jet ventilation is OK
In HFOV, what is the target FiO2?
55-65
How are CDH & MAS the same?
Signs of hypoxia Low APGAR Don't bag them. Gentile ventilation or HFOV Nitric Oxide ECMO: Last resort
MAS pt’s need _____. CDH pt’s need ____
MAS needs suctioning. CDH needs intubation and surgery
Complications of nitric oxide delivery
Methmoglobinemia (rare)
inadvertent nitrus oxide delivery
Hyperthermia (rare)
Four conditions that nitric oxide should be considered.
Neonatal pulmonary HTN secondary to MAS or diaphragmic hernia
Hypoxia
Bad lung development
ECMO avoidance
These maternal factors do not cause BPD (x3)
Pregnancy induced HTN
Prenatal Steroids
Maternal Age
Two things that do not cause BPD:
The baby’s ____
A low ______
Also, the _____ ______ will not cause BPD.
Gender
Low APGAR
Delivery route
What systems are involved with CF?
Pulmonary, digestive, endocrine, and reproductive
You will have a 25% chance of getting CF if ___.
Both parents carry the gene.
What are the CF transplant eligibility factors?
Severe CF
No other organ failure
Can’t have Burkholderia Cepacia
What are the success rates of transplant for CF patients? ___ live beyond one year and ____ live beyond 5 years.
90%
50%
RCP interventions for mild flail chest
Pain meds
Bronchial hygiene
RCP interventions for severe flail chest: For instability or paradoxical breathing, use __ __.
Set __ on the ventilator.
Monitor for __ __.
Pharmacology: Use __.
For instability or paradoxical breathing, use Mech Ventilation
PEEP
Monitor for ARDS onset
Sedation
How do you figure out ET tube depth?
Use ET tube size x3
What is the most common cause of pediatric ARDS?
Septic shock is most common
What does a swimming pool have to do with the causes of pediatric ARDS?
Near drowning can cause it.
What kind of trauma can cause pediatric ARDS?
Blunt chest trauma- pulmonary contusion
RSV patients are usually ___ months old.
4-6
RSV is most common during these times of the year.
Autumn and winter, also early spring
Symptoms of RSV include these upper airway symptoms.
What kind of lung sounds (x2)
Heart rate will be __.
This will be noted with breathing.
Fever, runny nose, cough Moist wheezes Upper airway crackles Tachypnea Retractions
What does an RSV virus look like under a microscope?
How is it spread?
Variably shaped RNA virus.
Spread by close contact with respiratory secretions of an infected person, or droplet inhalation, or by contact with contaminated surfaces.
What percentage of children with RSV will be symptomatic?
25-40%
What percentage of children with RSV will need hospitalization?
0.5-2%
How long does it take to recover from RSV?
About 1-2 weeks
RSV is more dangerous amongst children with pre-existing ___, ___, or ___ conditions.
Cardiac, pulmonary, or immunosuppressant
Which babies are most at risk of RSV?
Ex-Premies
Infants <6 weeks old
Former BPD patients
Children are more at risk of RSV if they are not _____.
Not breastfed
Babies at risk of RSV are given ___.
Synagis
Do not give ___ to RSV patients. Instead, you can try ___.
Do not give Albuterol.
Nebulized racemic epinephrine may help.
For severe RSV patients, treatment may include (Ventilatory modalities)
CPAP or BIPAP
Heated high flow n/c
Mech ventilation
For severe RSV patients, treatment may include (Drugs)
Ribavirin
Lasix
Croup has this telltale sign on an Xray:
Pencil Point Sign
Epiglottitis has this telltale sign on an Xray:
Thumb Sign
Croup is (bacterial / viral) Epiglottitis is (bacterial / viral)
Croup is viral (usually)
Epiglottitis is bacterial
Croup is (above/below) the trachea Epiglottitis is (above/below) the trachea
Croup: Below the trachea
Epiglottitis is above
Why is Mg effective in asthma?
Inhibits smooth muscle contraction
Decreases histamine release
Decreases acetylcholine release
How do you minimize air trapping in an asthmatic?
Low respiratory rates
Long expiratory times
Consider PHY
Ventilator considerations for status asthmatic?
PC/SIMV, rate of 12. Monitor optimal resp rate and inspiratory time when the wave form goes back to baseline.
When ventilating a baby with pulmonary hypertension, __ is preferred.
Secondary is __ __ and __ __ ventilation due to __ __.
Ventilation: HFOV is preferred.
Secondary is low PIP & low PEEP ventilation due to hypoplastic lung
