Neonate/OB Emergencies Flashcards
What is TOF?
Tetralogy of Fallot Is the MOST common cyanotic heart defect and the most common cause of Blue Baby Syndrome
What are the four heart defects for TOF?
Pulmonary stenosis
- A narrowing of the pulmonary valve (valvular stenosis) or just below it (Infundibular stenosis)
Right Ventricular Hypertrophy
- increase in size of the ventricle while compensating for obstruction
Overriding Aorta
- An Aortic valve with biventricular connection to the left and right ventricles
Ventricular Septal Defect
- A hole between the bottom two ventricles
VEALS / CHOPE
Variable Decel - Cord compression Early Decel - Head compression by cervix Accelerations - Ok~fetal well being Late Decel - Placental~Uterus insufficient Sinusoidal - Emergency C Section
What are signs of subtle seizures?
- Repetitive mouth/tongue movement
- Bicycling movement
- Eye deviation
- Staring
- Apnea
- Repetitive blinking
What is Prostaglandins E1?
It’s used during transport for neonates that depend on their Patent Ductus Arteriosus for pulmonary flow
Neonatal ET Tube size Estimates
Preterm = 3.0 or 2.5(if less than 28 weeks)
Full-term = 3.5
One year = (Age in years + 16) / 4
What is PPHN and what is the cause?
Persistent Pulmonary Hypertension
Right-to-Left shunt
What are the side effects for prostaglandins E1 (PGE1)?
-Apnea and Hyperventilation
- Fever
- Vasodilation
- Diarrhea
What is Patent Ductus Arteriousus?
It is a vessel that connects the pulmonary artery to the aortic arch. It allows blood flow from the RV to bypass the lungs going into fetal circulation.
How do you accelerate PDA closure?
Administer Indomethacin or ibuprofen
How do you keep the PDA open?
Administer Prostaglandin E1
Administration can cause apnea
What are neonate defects?
Ventricular Septal Defect
-A hole between the two bottom chambers of the ventricles
Overriding Aorta
-An aortic valve with a Bi-ventricular connection to the left and right ventricles
Right Ventricular Hypertrophy
-Increase in size while compensating for obstruction
Pulmonary Stenosis
-Narrowing of the pulmonary valve or just below it
What is the Tetralogy of Fallot
What is the Urine Output for children?
Newborn - 1 year
2mL/kg/Hr
Toddlers
1.5mL/kg/Hr
Adolescent
1mL/kg/Hr
When should a Blood transfusion be initiated?
After 40 - 60ml/kg of fluids are given
What are the Symptoms and Antidotes for Ethylene Glycol Poisoning?
(Sweet Taste)
- Intoxicated
- Metabolic Acidosis
- Cardiovascular Dysfunction
- Acute Kidney Failure
ANTIDOTES
- Ethanol
- Fomepizol
What is Reye’s Syndrome
Aspirin overdose [Fatal]
Persistent Pulmonary Hypertension (PPHN)
It results in a Right-to-Left Shunt
For children younger than 10, where is the narrowest portion of the trachea?
The cricoid process
Steeple sign is a sign of?
Tracheal narrowing /Croup
What is a Diaphragmatic Hernia?
When the pleuroperitoneal cavity fails to close
-Cause by early gestation
What qualifies as Hypoglycemia?
-A serum glucose less than 40
TREATMENT
2-4mL/kg of D10% BOLUS
80mL/kg/24hrs of 10% Dextrose
Important details for pediatric Nasal Intubations
- Never perform on kids less than 12 years old
- The acute angle makes it difficult
What is Kehr’s sign?
Left shoulder pain due to diaphragmatic irritation from bleeding
(Indicates Splenic Rupture)
What is the Years to Weight (kg) formula?
(Age in years x 2) +8 = ____kg
What is the circulating blood volume for Newborns, Pediatrics, and Adults?
Newborns
80mL/kg
Pediatric
70-80mL/kg
Adult
60mL/kg
Who can get needle cric’s, and who can get surgical cric’s?
Needle Cric’s=Younger than 11 years old
Surgical Cric’s=Older than 11 years old
What is the best treatment for bronchiolitis?
Intubate and ventilate is best
Steriods are not indicated
Infants on room air with acute hypoxia indicates?
A fixed right to left shunt. Which means deoxygenated blood is mixing with oxygenated blood
Simultaneous ABG’s with a difference greater than 10mm for PO2 indicates?
A right to left shunt
Are Neonate’s nose breathers or mouth breathers?
Nose breathers
Suction the mouth first, then nose
What is dangerous about meconium and when deep suction indicated?
- Surfactant is an activated by meconium
- Only when the neonate is not vigorous Deep suction is indicated
What is the official weight and age for a preterm neonate?
Less than 5 lbs / less than 28 days from DOB
What are the top three killers in the first 24 hours
- sepsis
- respiratory complications
- cardiac problems
What is a common causes and treatment for neonatal sepsis?
- Most common cause is Group B Strep
- Treatment is Ampicillin + Gentamicin
 For every increase of 1° over 37° how much does your heart rate increase?
10 BPM
What is respiratory distress syndrome?
It is the number one killer of premature infants. It causes a surfactant deficiency. Consider giving surfactant (via ET tube) when transporting.
What is Persistent Pulmonary Hypertension (PPHN)?
”Right to Left Shunt”
it is when a patient has pulmonary hypertension that causes hypoxia.
* consider giving surfactant with 100% O2*
What is Omphalocele?
It’s when the abdominal wall is under developed, and the intestines protrude from the abdomen.
What is a Ventriculoperitoneal Shunt (VP)?
It is a drain for patients with increase CSF in congenital hydrocephalus (water on the brain)
Shaken baby syndrome causes what kind of injury?
Diffuse axonal injury (DAI)
What is the 2/3/4 Rule?
2 x ETT size = Suction/NG Foley diameter
3 x ETT size = insertion depth
4 x ETT size = Chest Tube size
What is Becks triad?
Muffled heart tones
Hypovolemia
JVD
Narrowed Pulse Pressures
How low can your hemoglobin and hematocrit get before you need blood products?
Hemoglobin <6
Hematocrit <30%
What are the symptoms for Diabetes Insipidus?
Polydipsia = Excessive Thirst Polyuria = Excessive urination Polyphasic = Excessive hunger
What is the treatment for Diabetes Insipidus?
- IV Fluids
- Vasopressin
