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nnp i > DR ER WK1 > Flashcards

DR ER WK1 Flashcards

1
Q

Birth Injury: Incidence

A
  • 2% singleton vag cephalic
  • 1.1% c/s
  • <2% neonatal death rt birth injury
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2
Q

Birth Injury: DR Complications

A
  • Acute blood loss and shock
  • Respiratory insufficiency or failure
  • Risk neurological or organ impairment
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3
Q

Birth Injuries: Risk Factors

A
  • BMI >30
  • Macrosomia >4,000
  • Abnormal presentation (esp vag breech)
  • Instrumentation
    • Forceps
    • Vacuum
  • Shoulder dystocia
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4
Q

Volume Expansion DR: Indications

A
  • suspected blood loss
  • hypovolemic shock
  • palor
  • weak pulse
  • poor perfusion
  • HR fail to increase w other measures
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5
Q

Volume Expansion DR: Agents

A
  • Uncrossmatched O- whole blood
  • Crystalloid infusion (NS)
  • NOT colloid infusions (albumin)
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6
Q

Volume Expanders DR: Dosing

A
  • 10-20mlkg
  • Repeat doses PRN
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7
Q

Volume Expansion DR: Dosing

A
  • 10-20mlkg
  • Repeat doses PRN
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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
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9
Q

ICH: Risk Factors

A
  • Instrumentaiton
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10
Q

ICH: s/s

A
  • Apnea
  • Seizures
  • Resp depression
  • Altered tone
  • Decrease LOC
  • Increase irritability
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11
Q

ICH: MGMT

A
  • Common no urgent mgmt DR
  • s/s + instrumentation →
    • CUS asap
    • Definitive study
      • CT
      • MRI
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12
Q

Extracranial Injuries: Types

A
  • Caput succedaneum
  • Cephalohematoma
  • Subgaleal hemorrhage - rupture veins subgaleal space (between skull periosteum and epicranial aponeurosis)
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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
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14
Q

Subgaleal Hemorrhage: Risk Factors

A
  • Instrumentation (esp vacuum)
  • Vacuum cup marks
    • Over sagittal suture
    • <3cm anterior fontanel
  • Nulliparity
  • APGAR <8 5min
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15
Q

Subgaleal Hemorrhage: s/s

A
  • Fluctuant swelling
  • Crosses suture lines
  • Poorly defined edges
  • Anteriorly displaced ears
  • Pallor
  • Hypotonic
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16
Q

Subgaleal Hemorrhage: Complicaitons

A
  • Mortality 10-15%
  • Hypovolemic shock
  • Consumptive coagulopathy (esp large bleed)
  • Hyperbili
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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
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18
Q

Subgaleal Hemorrhage: DX

A
  • CUS - rapid assessment
  • CT/MRI - definitive f/u
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19
Q

Nerve Palsies: Types RT Birth Trauma

A
  • Facial nerve palsy
  • Brachial plexus palsy
  • Phrenic nerve palsy
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20
Q

Phrenic Nerve Palsy: Incidence

A
  • 1:15,000 live births
  • 80% unilateral (esp R side)
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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
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22
Q

Phrenic Nerve Palsy: Risk Factors

A
  • Shoulder dystocia (hightest risk)
  • Macrosoma
  • Instrumented
  • Vag breech
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23
Q

Phrenic Nerve Palsy: Complications

A
  • Mortality 10-15%
  • Sig respiratory distress
  • Diaphragmatic paralysis (esp w brachial plexus injury)
  • Low Apgar
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24
Q

Diaphragmatic Paralysis: s/s

A
  • Paradoxical (see-saw breathing)
  • Tachypnea
  • Cyanosis soon after delivery
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25
Q

Phrenic Nerve Palsy: MGMT

A
  • 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
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26
Q

Phrenic Nerve Palsy: DX

A
  • CXR - pos wnl w PPV
  • US (preferred) - lack or paradoxical diaphragmatic movement
27
Q

Spinal Cord Injuries: Types

A
  • Upper cervical (common)
  • Lower cervical
  • Thoracic
28
Q

Upper Cervical Injury: Incidence

A

0.15:10,000

29
Q

Spinal Cord Injuries: Risk Factors

A
  • Vag breech
  • Instrumented delivery
  • Forceps rotation >90degrees (esp upper cervical)
  • Vertex delivery (esp upper cervical)
  • Severe shoulder dystocia
30
Q

Spinal Cord Injuries: Complications

A
  • Mortality
  • Hypotonia
  • Flaccid tetraplegia or paraplegia
  • Respiratory distress
  • Apnea (esp upper cervical)
  • Vertebral fractures and spinal dislocations
31
Q

Spinal Cord Injuries: DX

A
  • US
32
Q

Spinal Cord Injuries: MGMT

A
  • 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
Q

Spinal Cord Injuries: Outcome Prediction

A
  • Age of 1st spontaneous breath and rate of recovery motor function <3m predict outcome
34
Q

Visceral Injuries: Locations

A
  • Hepatic (common)
  • Adrenal (esp R)
  • Splenic
35
Q

Visceral Injuries: Types

A
  • Solid organ injury
  • Solid organ rupture
36
Q

Solid Organ Injury: Patho and Phases

A
  • Phase 1 - initial subcapsular hemorrhage
  • Phase 2 - rupture hematoma → hemoperitoneum
37
Q

Solid Organ Injury: s/s

A
  • Anemia
    • Tachycardia
    • Tachypnea
    • Poor feed
  • Delayed presentation if contained w/in capsule
38
Q

Solid Organ Rupture: s/s

A
  • Acute decompensation
  • Sudden pallor
  • Classic triad - shock, anemia, blue discoloration abdomen
39
Q

Visceral Injuries: Risk Factors

A
  • Macrosomia
  • Breech
  • Difficult delivery
  • Instrumentation
  • Chest compressions
40
Q

Visceral Injuries: Complications

A
  • Organ rupture
  • Severe hemorrhage
  • Hemoperitoneum
  • Mortality
  • Hypovolemic shock
  • Persistent coagulopathy
  • Adrenal insufficiency (w sustained bilateral adrenal hemorrhage, rare)
41
Q

Visceral Injuries: Dx

A
  • Abdominal US
  • Confirm source - CT
42
Q

Visceral Injuries: MGMT

A
  • 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
Q

Birth Injuries: s/s Ongoing Blood Loss

A
  • Decrease hct
  • Increase FOC
    • +1cm = 30-40ml blood loss
  • Tachycardia
44
Q

CCHD: Types

A
  • 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
Q

CCHD: Types cause inadequate flow O2 blood systemic circulation (decrease intracardiac mixing)

A
  • D-TGA w RAS
46
Q

CCHD: Types decrease pulmonary venous egress

A
  • TAPVR
  • HLHS w RAS
47
Q

CCHD: Types associated lung or airway anomaly compromises O2 and vent

A
  • Severe Ebstein anomaly
  • TOF absent pulmonary valve
48
Q

CCHD: Decrease CO

A
  • severe arrhythmias
  • decrease cardiac function in isolation or w CHD
49
Q

CCHD: DR Prep

A
  • Review fetal echo
  • Decide if delayed cord clamping
  • Decide who’s attending
  • Decide level of care (cardiologist, reviewed by team)
50
Q

CCHD: DR what to expect

A
  • Intubation
  • UVC
  • Chest compression
  • Thoracentesis or pericardiocentesis pos
51
Q

CCHD: DR special equipment to set up

A
  • UVC kit w line flushed
  • NS 20-30ml/kg boluses
  • Pos thoracentesis set up
  • Prefilled epinephrine syringes
52
Q

CHD Severity Scale: Levels

A
  • Level 1 - low risk
  • Level 2 - intermediate
  • Level 3 - moderate
  • Level 4 - high
53
Q

CHD Severity Scale: ER cardiac intervention

A
  • Level III - pos
  • Level IV - likely
54
Q

CHD Severity Scale: PGE Dependent

A
  • Level III - likely
  • Level IV - likely
55
Q

CHD Severity Scale: Mode of delivery issues

A
  • Level III - pos
  • Level IV
56
Q

CHD Severity Scale: Neonatologist DR

A
  • Level II - pos
  • Level III
  • Level IV
57
Q

CHD Severity Scale: Transport Needed

A
  • Level II - pos
  • Level III
  • Level IV
58
Q

CHD Severity Scale: Cardiology/OR/CTICU Standby

A
  • Level III - pos
  • Level IV
59
Q

CHD Severity Scale: Level I Types

A
  • ASD
  • VSD
  • Mild PS
60
Q

CHD Severity Scale: Level II Types

A
  • CAVC
  • TOF/PS
  • Truncus Arteriosus
61
Q

CHD Severity Scale: Level III Types

A
  • HLHS
  • TOF/PA
  • PA/IVS
62
Q

CHD Severity Scale: Level IV Types

A
  • D-TGA/RAS
  • HLHS/RAS
  • Obstructed TAPVR
63
Q

CHD: Incidence

A
  • 1% live births
  • 25% require intervention

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