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15 Cards in this Set
- Front
- Back
How often do you see meconium aspiration and in who?
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-10-15% of deliveries
-Rare before 34 wk. Common in postmature infants. |
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Why is it so bad?
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-It can plug the airways and cause pulmonary pneumonitis. Predisposing the infant to pulmonary hypertension.
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What do you do for meconium aspiration babies?
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1.CR/Pox. Pox< 94 : hood oxygen and ABG. O2 >30% - place UAC.
2.CBC/chemstrip/Hgb/ Bcx/CXR 3.Abnl CBC, need oxygen, distress, or abnl CXR --> abx. 4.Echo if evidence of pulm HTN (O2, NO) |
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What causes RDS?
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Deficiency of pulmonary surfactant.
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Who is at increased risk for RDS?
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-Prematurity
-Maternal diabetes -Asphyxia -Male -Hydrops fetalis |
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What happens when you don't have enough surfactant around?
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Leads to alveolar atelectasis:
-Low lung volumes -Stiff lungs -Increased shunt (V/Q mismatch) -Increased pulm vascular resistance (less pulm blood flow) -Increased WOB |
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How do babies present with RDS?
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-Tachypneic, retracting, grunting
-Cyanosis -Apnea |
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When does RDS usually present?
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-Almost always at birth
-Peak at 2-3 days |
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What do you see on lab with RDS?
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-L/S (lecithin/sphingomyelin)<2.5
-Negative PG (phosphatidylglycerol) |
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What do you expect to see on blood gases for RDS?
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Hypoxemia --> Hypercarbia --> Metabolic acidosis
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What do you see on CXR?
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-Low lung volumes
-Homogeneous ground glass hypoaeration -Air bronchograms |
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What else should you be thinking on your DDx besides RDS?
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-Congenital PNA ( in near term infants, assume it is GBS unless proven otherwise)
-CHD -TTN (dx of exclusion) |
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How do you treat RDS?
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1.Restrict fluid - b/c diuresis is delayed in RDS and doesn't start till day 2-3.
2.Respiratory improvement starts 12 hr after diuresis begins. <1000g 80-100 cc/kg/d >1000g 60-80 cc/kg/d 4.Pox 88-94% -NCAP (5-8 cm H20) -Ventilator 5.Survanta (4 cc/kg) - should hear bubbling after given 6.Caffeine - prior to extuabeion in infants less than 30 wk |
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What are some complications with RDS?
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1.Pulmonary interstitial emphysema
2.Pneumothorax 3.PDA - deteriorate or has pulmonary hemmorage 4.BPD |
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When to you exxtubate RDS to NCPAP?
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1.FiO2 <40
2.PIP <20, MAP<7 3.Stable |