Respiratory and Cardiac Conditions Flashcards
factors that impair fluid removal in the lungs
CAESAR SURFS END HY SEDATES
caesarian birth surfactant deficiency endothelial cell damage hypoalbuminemia sedation of the baby
t/f rds is 60-70% more common in <28 aog
false, 60-80%
main features of rds
surfactant deficiency -> increased alveolar surface tension -> ateletasis or atelectrauma and impaired frc
establishment and maintenance of ____ leads to optimal exchange of oxygen and carbon dioxide between alveoli and blood
functional residual capacity (expiratory reserve volume + residual volume)
mature levels of surfactant are present at ___
35 aog
sequelae of rds
atelectasis (perfused but not ventilated alveola) -> hypoxia, hypercapnia, acidosis, pulmonary arterial vasoconstriction, epithelial cell injury -> hyaline membrane formation
clinical manifestations of rds
rapid shallow breathing expiratory grunting chest retractions nasal flaring cyanosis
preventive management for rds
avoid cs for <39 aog
antenatal steroids before 37 aog (esp with premature)
how to establish frc for rds management
ncpap mechanical ventilation (for respiratory failure or persistent apnea)
what is apnea
prolonged cessation of breathing
- > 20 s
- <20 s + change in tone, pallor, cyanosis, bradycardia
surfactant replacement therapy in rds
INSURE = INtubate, administer SURfactant through et, Extubate
MIST / LISA = invasive
self limited tachypnea associated with delayed clearance of fetal lung fluid. early onset tachypnea in term infants.
transient tachypnea of the newborn
pathogenesis of ttn
ineffective expression or activity of enac and na-k atpase -> decreased pulmonary compliance and impeded gas exchange
clinical manifestations of ttn
respiratory distress with rapid recovery
no radiographic findings of rds
management for ttn
supportive care
inhaled b2 agonist albuterol
t/f meconium aspiration is most common in preterm neonates
false, post term after 42 aog
meconium aspirated in utero or with first breath can result to
small airway obstruction and respiratory distress = grunting and cyanosis
complete obstruction of airway = _______
partial obstruction = ____
complete obstruction = atelectasis and ventilation-perfusion mismatch
partial obstruction = half valve effect, air trapping, and air leaks
both = acidosis, hypoxemia, hypercapnia
xray for meconium aspiration
patchy infiltrates coarse streaking of both lung fields
increase in ap diameter
flattened diaphragm
management for meconium aspiration
preventive: identify and deliver
supportive: exogenous surfactant, inhaled NO, mechanical ventilation, extracorporeal oxygenation
pathogenesis of congenital pneumonia
aspiration or ingestion of bacterial in amniotic fluid (maternal chorioamnionitis)
clinical manifestations of congenital pneumonia
before delivery: fetal distress, tachy
during: failure to breathe, rd, shock
after: rd and shock
treatment for congenital pneumonia
ampicillin iv (g+) gentamicin (g-) ampicillin + cefotaxime (after discharge)
vessel transpositions in toga
aorta from rv
pulmonary artery from lv
obligatory shunts in toga
patent foramen ovale
patent ductus arteriosus
t/f in a pfo oxygenated blood will be shunted from left to right atrium
true
t/f in a pda in toga, oxygenated blood from the aorta will go to the pulmonary artery
false, pulmonary artery to aorta
clinical manifestations of toga
tachypnea and cyanosis in the first hours of life
moderate to severe hypoxemia
nonspecific pe findings
diagnostic findings in toga
cxr: egg shaped heart
diagnostic ecg
cardiac catheterization
management of toga
pge1 (for pda)
rashkind ballon atrial septostomy (to enlarge pfo)
jatene procedure (arterial switch within first 2 weeks)
pathogenesis of tapvr
- pulmonary veins connect to ra = oxygenated blood goes to right side
- volume overload -> pressure increases -> ra and rv enlarge
- —> pulmonary hypertension, pulmonary congestion, pulmonary edema = pediatric cardiac surgical emergency
clinical manifestations of tapvr
respiratory distress and severe cyanosis not responsive to mechanical ventilation
crackles (pulm congestion/edema)
no murmur
loud single second heart sound
diagnosis for tapvr
ecg: rvh + rad
echo w doppler: asd
demonstration of any vein wiith doppler flow away from the heart is pathognomonic
management for tapvr
surgical correction
extracorporeal membrane oxygenation (ecmo)
components of tof
SHOP for a TOF
ventricular septal defect
rv hypertrophy
overriding aorta
pulmonary stenosis
pathophysio of tof
vsd: malalignment between canal septum and lower portion of ventricular wall
clinical manifestation of tof depends on __
degree of rv outflow tract obstruction (stenosis)
diagnostics of tof
boot shaped heart
management of tof
resection of obstructive muscle bundle
patch closure of vsd
blalock taussig shunt: palliative systemic pulmonary artery shunt to augment pulmonary artery blood flow
pathophysio of pulmonary atresia with intact ventricular septum
absent or poor pulmo valve + intact ventricular septum
source of pulmonary blood flow is pda
blood flow in pulmonary atresia with intact ventricular septum
blood from rv regurgitates into ra -> shunts to la via fo -> lv
management of pulmo atresia
pge1 infusion
surgery
