Case 25: Apnea, 2 Month Old

Front 1

CPR

Back 1

circulation

airway

breathing

Front 2

CAB efforts

Back 2

Tap the infant's foot to see if he responds.

Check for breathing.

If he is unresponsive and not breathing (or only gasping) begin CPR.

Front 3

ALTE

Back 3

Apparent life threatening event

Replaced "near-miss SIDS"

description of event

Front 4

ALTE event

Back 4

The observer finds the episode frightening and may think the infant has died.The caregiver's description usually includes apnea or change in breathing pattern, colorchange (cyanosis, pallor, erythema, plethora), change in muscle tone (usually limpness), andpossibly choking or gagging.Recovery occurs only after stimulation or resuscitation

Front 5

Differential Diagnosis?

Back 5

• CNS
  
• Cardiac
  
• Pulmonary
  
• Gastrointestinal
  
• Systemic
  

Front 6

CNS ALTE

Back 6

seizures (bleed, infection, structural abnormalities, metabolic disorder, lyte abnormalities, genetic syndromes or epilepsy)

breath holding spells

Front 7

Breath holding spells

Back 7

• occursduring expiration and is reflexive in nature.
  
• cries andthen suddenly falls silent in the expiratory phase of respiration.
  
• followed by a color change. S
  
• pallid(acyanotic) or cyanotic.
  
• Pallid spells are typically associated with aninjury such as a fall
  
• cyanotic spells with anger.
  
• mayresolve spontaneously, or the child may lose consciousness.
  

Front 8

Cardiac

Back 8

QT syndrome

SVT

congenital heart disease

Front 9

Pulmonary

Back 9

apnea is respiratory syncytial virus infection

pertussis

lower RI

Front 10

Gastrointestinal

Back 10

Reflux

swallowing abnormalities

tracheoesophageal fistula

Front 11

Systemic

Back 11

• sepsis: apnea, pallor, tachycardia, tachypnea, fever or hypothermia, decreased feeds or change in tone
  
• ingestion of meds/toxins
  
• botulinum
  
• environment exposures, carbon monoxide, mental status changes
  
• hypoxia
  

Front 12

Normal neurological findings in 2 month old

Back 12

• Can fix and follow easily with their eyes;
  
• Exhibit a meaningful smile in response to voices;
  
• Have a strong suck;
• andAre beginning to coo

Front 13

Subdural hematoma

Back 13

head trauma, accidental or non accidental

Front 14

Accidental trauma

Back 14

MVA

Front 15

abusive head trauma

Back 15

10-12% of all deaths among children who are victims of child abuse

Front 16

Role of physician in suspected child abuse cases

Back 16

determine likelihood injury was accidental or non-accidental

health care workers report suspected child abuse

Front 17

Team members in suspected child abuse

Back 17

• attending
  
• neurologist
  
• child advocacy doctor
  
• opthalmologist
  
• social worker
  

Front 18

neurologist

Back 18

If there is head trauma, a neurologist can help assess the extent of injury,recommend treatment, and provide follow-up monitoring.

Front 19

child advocacy doctor

Back 19

recommend specific studies,such as a skeletal survey to look for old or new fractures, or additional consultations needed toevaluate the possibility of abuse

Front 20

ophthalmologist

Back 20

Retinal hemorrhages, found in 65-90% of victims, is highly suggestive of abusivehead trauma, and is rarely seen for any reason other than severe accidental injury (e.g., highspeedmotor vehicle collision) or non-accidental trauma

Front 21

social worker

Back 21

team coordinators

Front 22

skeletal surveys are for...?

Back 22

• fractures
  
• multiple fractures at various stages of healing
  
• posterior rib fractures
  
• skull fracture
  

Front 23

Prognosis of victims of abusive head trauma?

Back 23

Many babies with subdural hematomas and retinal hemorrhages have long-term developmentaldelays, seizures, and/or difficulty with vision.

Front 24

Temperature of 2 month old?

Back 24

A normal rectal temperature is greater than 96.5° F and less than 100.4° F.

Front 25

Hear rate?

Back 25

Tachycardia may suggests a deterioration in cardiovascular status related to sepsis, shock,or increased ICP (intracranial pressure).

Front 26

Respiration rate?

Back 26

A decreased repiratory rate is suggestive of a CNS (central nervous system) depression ofthe respiratory center.Sepsis or a respiratory infection generally present with increased respiratory rate

Front 27

Blood pressure?

Back 27

An elevated blood pressure indicates a response from the cardiovascular system either topain, compensated shock, or increased ICP.

Front 28

How to discuss non accidental trauma with parents?

Back 28

gather more history

share info directly

ask parents for their ideas