PBLs and Sim day Flashcards
You are called to the post-natal ward. A 2 day old neonate has a “dusky episode” witnessed only by her mother. The nurse feels that he is now more quiet than usual and wants you to review him.
What is meant by a dusky episode?
Cyanosis. probably caused by apnea
How would you define apnea?
not breathing for <20s
What is the most common seizure in neonates? In children?
Neonates: Focal seizures (due to apnea)
children: Febrile seizures (due to infection)
You are called to the post-natal ward. A 2 day old neonate has a “dusky episode” witnessed only by her mother. The nurse feels that he is now more quiet than usual and wants you to review him.
What are the possible causes of this dusky episode?
Main:
“While feeding” -> Milk aspiration (classic case) and choanal atresia (confirmed via ET tube)
Sepsis
Congenital heart disease (PDA, tetrology…)
Febrile seizures
Preterm (underdeveloped lungs)
Other: RDS, anemia, HF, electrolytes
You are called to the post-natal ward. A 2 day old neonate has a “dusky episode” witnessed only by her mother. The nurse feels that he is now more quiet than usual and wants you to review him.
What are the relevant questions to ask in the history (briefly)
Specifics about episode (onset, symptoms, previously well, while feeding? before and after episode, how long)
Antenatal hx and birth hx
Family hx (specifically congenital heart disease, seizures)
APGAR and PEW scores
You are called to the post-natal ward. A 2 day old neonate has a “dusky episode” witnessed only by her mother. The nurse feels that he is now more quiet than usual and wants you to review him.
What information do you want to gain from your initial assessment? ABCDE
This is an initial assessment and is an emergency therefore it must be approached via ABCDE
A: airway patent? any obstruction? assess the airway
B: SpO2, HR, Resp distress sx, do they require oxygen or assisted ventilation?
C: color, cap refill, HR, BP
D (neuro): tone, abnormal movements, focal neuro exam
E (exposure): bruising, rashes etc…
You are called to the post-natal ward. A 2 day old neonate has a “dusky episode” witnessed only by her mother. The nurse feels that he is now more quiet than usual and wants you to review him.
What investigations might you carry out?
Thorough history
Sepsis screen
Cranial US to rule out neuro causes via anterior fontanelle
Full neuro, resp, and cardio exam (incl. cap refill)
ECG
ECHO/US for congenital abnormalities
Hypoglycemia
Chest X-ray
Pulse oximetry/blood gas
CFAM/EEG for neonates
Pass ET tube to check for choanal atresia
You are called to the post-natal ward. A 2 day old neonate has a “dusky episode” witnessed only by her mother. The nurse feels that he is now more quiet than usual and wants you to review him.
When conducting the sepsis screen, where would or could you get samples from?
Infant blood, urine, csf (LP)
Mother blood and urine
Plancental swab
You are called to the post-natal ward. A 2 day old neonate has a “dusky episode” witnessed only by her mother. The nurse feels that he is now more quiet than usual and wants you to review him.
When conducting a sepsis screen, what organism are you most concerned about? What organism is not covered under the typical AB given that we should be concerned about?
Group B strep
Concerned about fungal infections such as candida
You are called to the post-natal ward. A 2 day old neonate has a “dusky episode” witnessed only by her mother. The nurse feels that he is now more quiet than usual and wants you to review him.
What interventions might you perform?
Resp: caffeine > nasal cannula/ET > CPAP > mechanical ventilation
Fluid/BP/cap refill time: Dextrose or 0.9 saline.
Empiric Antibiotics: Benzylpenicillin and gentamicin for both gram +vs and -ve or ceftriaxone (3rd gen cephalosporin)
What particularly may make the neonate more susceptible to infection after being delivered in the hospital
thin, easy access through skin esp after birth trauma
resistant organisms in hospital
microflora of vagina and cervix + colonization with group B strep
invasive/indwelling parts that could be colonized by microorganisms
Give 2 appropriate stool investigations for IBD
Give 4 blood investigations for IBD
Stool culture
Fecal Calprotectin
Fecal Lactoferrin
FBC for anemia
CRP/ESR raised
Serology for IBD-specific markers (ASCA for crohns and pANCA for UC)
