DR ER WK1 Flashcards
(63 cards)
1
Q
Birth Injury: Incidence
A
- 2% singleton vag cephalic
- 1.1% c/s
- <2% neonatal death rt birth injury
2
Q
Birth Injury: DR Complications
A
- Acute blood loss and shock
- Respiratory insufficiency or failure
- Risk neurological or organ impairment
3
Q
Birth Injuries: Risk Factors
A
- BMI >30
- Macrosomia >4,000
- Abnormal presentation (esp vag breech)
- Instrumentation
- Forceps
- Vacuum
- Shoulder dystocia
4
Q
Volume Expansion DR: Indications
A
- suspected blood loss
- hypovolemic shock
- palor
- weak pulse
- poor perfusion
- HR fail to increase w other measures
5
Q
Volume Expansion DR: Agents
A
- Uncrossmatched O- whole blood
- Crystalloid infusion (NS)
- NOT colloid infusions (albumin)
6
Q
Volume Expanders DR: Dosing
A
- 10-20mlkg
- Repeat doses PRN
7
Q
Volume Expansion DR: Dosing
A
- 10-20mlkg
- Repeat doses PRN
8
Q
ICH: Types
A
- Subdural - rupture veins between dura mater and arachnoid layer
- Subarachnoid - rupture veins subarachnoid space or small leptomeningeal vessels
- Epidural - rupture middle meningeal artery
- IVH
9
Q
ICH: Risk Factors
A
- Instrumentaiton
10
Q
ICH: s/s
A
- Apnea
- Seizures
- Resp depression
- Altered tone
- Decrease LOC
- Increase irritability
11
Q
ICH: MGMT
A
- Common no urgent mgmt DR
- s/s + instrumentation →
- CUS asap
- Definitive study
- CT
- MRI
12
Q
Extracranial Injuries: Types
A
- Caput succedaneum
- Cephalohematoma
- Subgaleal hemorrhage - rupture veins subgaleal space (between skull periosteum and epicranial aponeurosis)
13
Q
Subgaleal Hemorrhage: Patho
A
- Hemorrhage under aponeurosis
- Traction scalp during delivery → shearing or severing emissary veins in subgaleal space
- Extends from orbital ridges to nape of neck
- 20-40% sequestration blood volume pos
14
Q
Subgaleal Hemorrhage: Risk Factors
A
- Instrumentation (esp vacuum)
- Vacuum cup marks
- Over sagittal suture
- <3cm anterior fontanel
- Nulliparity
- APGAR <8 5min
15
Q
Subgaleal Hemorrhage: s/s
A
- Fluctuant swelling
- Crosses suture lines
- Poorly defined edges
- Anteriorly displaced ears
- Pallor
- Hypotonic
16
Q
Subgaleal Hemorrhage: Complicaitons
A
- Mortality 10-15%
- Hypovolemic shock
- Consumptive coagulopathy (esp large bleed)
- Hyperbili
17
Q
Subgaleal Hemorrhage: MGMT
A
- Suspect w s/s (esp w instrument delivery)
- NICU NOT DR mgmt
- VS q1-4hr
- Serial FOC measurements
- Serial hct
- UVC w s/s ongoing blood loss
- Coag studies - rt risk consumptive coagulopathy w large bleeds
- Transfusion PRN coagulopathy
- FFP
- Cryoprecipitate
- Platelets
- Massive subgaleal hemorrhage - pos recombinant activated factor VII
18
Q
Subgaleal Hemorrhage: DX
A
- CUS - rapid assessment
- CT/MRI - definitive f/u
19
Q
Nerve Palsies: Types RT Birth Trauma
A
- Facial nerve palsy
- Brachial plexus palsy
- Phrenic nerve palsy
20
Q
Phrenic Nerve Palsy: Incidence
A
- 1:15,000 live births
- 80% unilateral (esp R side)
21
Q
Phrenic Nerve Palsy: Patho
A
- Phrenic nerve - originates anterior rami C3-C5, descends thorax, innervate diaphragm
- Source motor innervation diaphragm - contract w inspiration, dome shape exhalation
- Extreme lateral flexion and traction neck → injury
22
Q
Phrenic Nerve Palsy: Risk Factors
A
- Shoulder dystocia (hightest risk)
- Macrosoma
- Instrumented
- Vag breech
23
Q
Phrenic Nerve Palsy: Complications
A
- Mortality 10-15%
- Sig respiratory distress
- Diaphragmatic paralysis (esp w brachial plexus injury)
- Low Apgar
24
Q
Diaphragmatic Paralysis: s/s
A
- Paradoxical (see-saw breathing)
- Tachypnea
- Cyanosis soon after delivery
25
Phrenic Nerve Palsy: MGMT
* Sig respiratory distress - DR ER
* Consider w acute resp distress birth (esp w shoulder dystocia, brachial plexus injury, other risk factors)
* Plication diaphragm - if cannot wean resp support
26
Phrenic Nerve Palsy: DX
* CXR - pos wnl w PPV
* US (preferred) - lack or paradoxical diaphragmatic movement
27
Spinal Cord Injuries: Types
* Upper cervical (common)
* Lower cervical
* Thoracic
28
Upper Cervical Injury: Incidence
0.15:10,000
29
Spinal Cord Injuries: Risk Factors
* Vag breech
* Instrumented delivery
* Forceps rotation \>90degrees (esp upper cervical)
* Vertex delivery (esp upper cervical)
* Severe shoulder dystocia
30
Spinal Cord Injuries: Complications
* Mortality
* Hypotonia
* Flaccid tetraplegia or paraplegia
* Respiratory distress
* Apnea (esp upper cervical)
* Vertebral fractures and spinal dislocations
31
Spinal Cord Injuries: DX
* US
32
Spinal Cord Injuries: MGMT
* DR ER
* Immobilize head neck and spine w suspicion spinal injury
* XR frontal and lateral spine
* MRI
* W unclear nature
* Ddx - edema, ischemia, hemorrhage
* Early MRI may appear wnl
* MRI post acute phase predict long term prognosis
33
Spinal Cord Injuries: Outcome Prediction
* Age of 1st spontaneous breath and rate of recovery motor function \<3m predict outcome
34
Visceral Injuries: Locations
* Hepatic (common)
* Adrenal (esp R)
* Splenic
35
Visceral Injuries: Types
* Solid organ injury
* Solid organ rupture
36
Solid Organ Injury: Patho and Phases
* Phase 1 - initial subcapsular hemorrhage
* Phase 2 - rupture hematoma → hemoperitoneum
37
Solid Organ Injury: s/s
* Anemia
* Tachycardia
* Tachypnea
* Poor feed
* Delayed presentation if contained w/in capsule
38
Solid Organ Rupture: s/s
* Acute decompensation
* Sudden pallor
* Classic triad - shock, anemia, blue discoloration abdomen
39
Visceral Injuries: Risk Factors
* Macrosomia
* Breech
* Difficult delivery
* Instrumentation
* Chest compressions
40
Visceral Injuries: Complications
* Organ rupture
* Severe hemorrhage
* Hemoperitoneum
* Mortality
* Hypovolemic shock
* Persistent coagulopathy
* Adrenal insufficiency (w sustained bilateral adrenal hemorrhage, rare)
41
Visceral Injuries: Dx
* Abdominal US
* Confirm source - CT
42
Visceral Injuries: MGMT
* Non surgical mgmt preferred
* Hypovolemic shock
* Volume resuscitation - NS until blood arrives
* Clotting factor replacement PRN
* Persistent coagulopathy
* FFB
* Cryoprecipitate
* Platelet transfusion
* Laparotomy
* W continued bleeding
* AVOID splenectomy rt postsplenectomy sepsis
43
Birth Injuries: s/s Ongoing Blood Loss
* Decrease hct
* Increase FOC
* +1cm = 30-40ml blood loss
* Tachycardia
44
CCHD: Types
* Inadequate flow of O2 blood to systemic circulation (decrease intracardiac mixing)
* Decrease pulmonary venous egress
* Associated lung or airway anomaly that compromises O2 and vent
* Decrease CO
45
CCHD: Types cause inadequate flow O2 blood systemic circulation (decrease intracardiac mixing)
* D-TGA w RAS
46
CCHD: Types decrease pulmonary venous egress
* TAPVR
* HLHS w RAS
47
CCHD: Types associated lung or airway anomaly compromises O2 and vent
* Severe Ebstein anomaly
* TOF absent pulmonary valve
48
CCHD: Decrease CO
* severe arrhythmias
* decrease cardiac function in isolation or w CHD
49
CCHD: DR Prep
* Review fetal echo
* Decide if delayed cord clamping
* Decide who's attending
* Decide level of care (cardiologist, reviewed by team)
50
CCHD: DR what to expect
* Intubation
* UVC
* Chest compression
* Thoracentesis or pericardiocentesis pos
51
CCHD: DR special equipment to set up
* UVC kit w line flushed
* NS 20-30ml/kg boluses
* Pos thoracentesis set up
* Prefilled epinephrine syringes
52
CHD Severity Scale: Levels
* Level 1 - low risk
* Level 2 - intermediate
* Level 3 - moderate
* Level 4 - high
53
CHD Severity Scale: ER cardiac intervention
* Level III - pos
* Level IV - likely
54
CHD Severity Scale: PGE Dependent
* Level III - likely
* Level IV - likely
55
CHD Severity Scale: Mode of delivery issues
* Level III - pos
* Level IV
56
CHD Severity Scale: Neonatologist DR
* Level II - pos
* Level III
* Level IV
57
CHD Severity Scale: Transport Needed
* Level II - pos
* Level III
* Level IV
58
CHD Severity Scale: Cardiology/OR/CTICU Standby
* Level III - pos
* Level IV
59
CHD Severity Scale: Level I Types
* ASD
* VSD
* Mild PS
60
CHD Severity Scale: Level II Types
* CAVC
* TOF/PS
* Truncus Arteriosus
61
CHD Severity Scale: Level III Types
* HLHS
* TOF/PA
* PA/IVS
62
CHD Severity Scale: Level IV Types
* D-TGA/RAS
* HLHS/RAS
* Obstructed TAPVR
63
CHD: Incidence
* 1% live births
* 25% require intervention
