CVPR Week 9: Pediatric pulmonology Flashcards
(64 cards)
1
Q
Objectives
A
2
Q
General approach to a clinical problem
A
3
Q
The approaches to respiratory distress in the neonate
A
4
Q
Neonate is having respiratory distress now what?
A
5
Q
Neonate is having respiratory distress historical components
A
6
Q
Neonate is having respiratory distress: Physical exam
A
- Color
- Work of breathing (rate, retractions)
- Pulse oximeter
- Shape of chest and belly
- Obvious malformations
- Pulses/perfusion/BP
7
Q
Neonate is having respiratory distress: Tests
A
- CXR & other imagery
- blood work
- consultant evaluations
8
Q
Case 1
A
9
Q
Describe
A
10
Q
What causes these?
A
11
Q
What is this?
A
12
Q
Key history for tracheoesophageal polyhydramnios
A
Maternal polyhydramnios
13
Q
Clinical presentation of tracheoesophageal fistula
A
- choking
- gurgling
- noisy respiratory distress
14
Q
Prevalence of tracheoesophageal fistula
A
relatively common 1:3,000 births
15
Q
Common comorbidities of tracheoesophageal fistula
A
- Multiple anomalies 80%
- Congenital heart disease - 20%
- Imperforate anus -10%
16
Q
VACTERL association
A
Vertebral-rib, anus, cardiac, TEF, renal, limb anomaly
17
Q
TEF AKA
A
tracheoesophageal fistula
18
Q
Types of TEF
A
19
Q
Reevaluate clinical vignette
A
20
Q
Prenatal evaluation of the respiratory system
A
21
Q
What is Polyhydramnios?
A
Too much amniotic fluid
22
Q
Polyhydramnios features
A
23
Q
What is oligohydramnios?
A
Too little amniotic fluid
24
Q
Oligohydramnios features
A
25
PE of neonate with respiratory problems
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What is this?
27
Surfactant is produced by?
Type II pneumocytes
28
What is surfactant and what does it do?
* It is a complex molecule that is part protein part phospholipid and it
* lowers surface tension when surface area is small
* increases Surface Tension when a surface area is large
29
What does surfactant directly oppose?
Laplace's law
30
What would happen without surfactant?
* small alveoli would deflate
* large alveoli would inflate
31
The physiological consequence of not having surfactant
a pattern of atelectasis and hyperinflatiion would emerge
and upon ventilation air would preferentially go to already large alveoli and avoid deflated alveoli
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Premature birth and respiratory distress syndrome
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Surfactant deficiency does what to lung compliance?
34
Risk factors for surfactant deficiency
* Prematurity 28 GA
* Gestational diabetes
* Male/White/Twins
* Previously affected sibling
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Clinical features of surfactant deficiency
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RDS AKA
Respiratory distress syndrome
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Antenatal Tx of RDS
Delay birth - Tocolysis, bedrest
Administer antenatal corticosteroids (betamethasone, dexamethasone)
38
Post-natal Tx of RDS
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What is surfactant replacement therapy?
synthetic product from bovine and ovine
40
Conditions that may mimic RDS in life
41
TTN AKA
Transient tachypnea of the newborn
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Transient tachypnea of the newborn features
* term or near term
* C-section
* CXR shows increased fluid but NOT ground glass opacities
* gets better after 2-3 days
43
Transient tachypnea of the newborn excess interstitial lung fluid causes?
reduced lung compliance
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Transient tachypnea of the newborn presentation
* Cesarean section delivery / short labor
* Late preterm delivery
* Tachypnea/grunting/retractions/nasal flaring
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CXR of Transient tachypnea of the newborn
normal lung volume, increased interstitial lung markings
46
Transient tachypnea of the newborn duration
usually self-limited to 24-48 hours
47
What is a diaphragmatic hernia
48
Diaphragmatic hernia pre-natal pulmonary complications
* inadequate fetal respiratory movements
* poor lung inflation in utero (with amniotic fluid)
* lung underdevelopment
* pulmonary hyperplasia
* pulmonary vascular underdevelopment
* set up for pulmonary HTN post-natally
49
Diaphragmatic hernia post-natal pulmonary complications
* insufficient respiratory movements
* inadequate ventilation
* can be fixed with positive pressure ventilator support
* Pulmonary HTN
* since pulmonary vascular bed is underdeveloped
* the pulmonary vascular system remains a high resistance system
* even if available vessels dilate (normal)
* pHTN may be refractory due to poor vasculature development
* May need ECMO Extra Corporeal Membrane Oxygenation
50
51
Diaphragmatic hernia presentation
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Diaphragmatic hernia Incidence and mortality
1:3000 births
high mortality depending upon severity
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What is this?
54
Identify
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Types of pulmonary HTN in an infant
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Pulmonary HTN in an infant presentation
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Pulmonary HTN in an infant lung compliance and volume
normal lung compliance / increased lung volume
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Pulmonary HTN in an infant oxygenation
* worsening oxygenation with poor response to oxygen
* mechanical ventilation
* cascades to respiratory failure
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Pulmonary HTN in an infant CXR
anywhere from abnormal to clear
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Pulmonary HTN in an infant ECHO
indirect signs of Pulmonary HTN
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Pulmonary HTN in an infant - pulmonary hypoplasia
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Pulmonary HTN in an infant - PPHN
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PPHN AKA
Persistent pulmonary hypertension of the newborn
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Pulmonary HTN in an infant PPHN treatment
