Simulation 08: Cyanotic Preterm Infant in Respiratory Distress
|
|
- Priscilla Park
- 5 years ago
- Views:
Transcription
1 Flow Chart Simulation 08: Cyanotic Preterm Infant in Respiratory Distress Opening Scenario Section 1 Type: DM As staff therapist assigned to a Level 2 NICU in a 250 bed rural medical center you are called to the delivery room to assist in the respiratory management of a newborn infant Infant HR = 122/min; RR = 43/min and irregular; preductal SpO2 = 72%. Recommend oxygen therapy by mask Section 2 Type: IG Section 3 Type: IG Section 4 Type: DM Section 5 Type: DM Assess: Maternal Hx - 19 YO diabetic g3p0; infant 28 week/1200 g; Apgar 4/6; central cyanosis+retractions; no L/S results but no bubbles in foam shake test; no meconium observed SpO2=79% (35% O2); HR=128; RR=58/ breath sounds, cyanotic +grunting. After O2 to 40%, ph=7.31, PCO2=51, PO2=45. Recommend CXR, echo, hyperoxia test, pre-/post ductal SpO2. X-ray: reduced lung volume, reticulogranular appearance + air bronchograms; echo = mod L>R PDA; recommend surfactant replacement therapy Recommend INSURE (INtubation-SURfactant-Extubation) approach, followed by 4 to 6 cm H2O nasal CPAP End
2 Opening Scenario (Links to Section 1) Scenario Header (Briefly describe the setting, role and current situation): You are the staff therapist assigned to the Level 2 Special Care Nursery in a 250 bed rural medical center. You are called to the delivery room to assist in the respiratory management of a newborn infant. (Click the Start button below when ready to begin) 2
3 Decision-Making Section Simulation Section #: 1 Links from: Opening Scenario Links to Section #(s): 2 You arrive about 5 minutes after an uncomplicated vaginal birth. The male infant has been dried, is covered by a plastic membrane and is under a radiant warmer. His heart rate is 122/min. Respirations are about 43/min, interspersed with short (5-10 sec) periods of apnea. His SpO2 (right hand) is 72% on room air. Which of the following would you recommend at this time? (CHOOSE ONLY ONE unless you are directed to Make another ) Action/Recommendation Link to Score Section Intubate and place on volume Physician disagrees. Make another -2 control A/C ventilation Initiate nitric oxide therapy (ino) Physician disagrees. Make another -2 Begin chest compressions and manual (bag-mask) ventilation Physician disagrees. Make another -1 Start oxygen therapy by mask Physician agrees Administer IV dexamethasone Physician disagrees. Make another -2 Perfect Score: 2 Minimum Pass Score: 2 3
4 Information-Gathering Section Simulation Section #: 2 Links from Section #: 1 Links to Section #(s): 3 Which of the following additional information would you obtain at this time? (SELECT AS MANY as you consider indicated in this Section, then click on the Go To Next Section button below to proceed to the next Section.) Requested Information: Data Score Maternal history Diabetic 19 year old Caucasian; gravida 3, +2 para 0; did not receive any prenatal care Foam shake test (pharyngeal Negative (no bubbles) +1 secretions) Capillary blood gas Physician disagrees -1 Gestational age and birth weight 28 weeks (estimated)/1200 g +2 General inspection/appearance Moderate central cyanosis, slight +2 intercostal retractions during inspiration Moro reflex Absent -1 Amniotic lecithin/sphyngomyelin Amniotic fluid not obtained +1 (L/S) ratio Apgar score 1 minute = 4; 5 minute = 6 +2 Ballard maturity assessment Not performed at this time -1 Presence of meconium None observed on baby or in pharynx +1 Perfect Score: 11 Minimum Pass Score: 8 4
5 Information-Gathering Simulation Section #: 3 Links from Section #: 2 Links to Section #(s): 4 After transfer to NICU, the infant is placed in an isolette on a cardiorespiratory monitor and an umbilical artery line is inserted. On 35% O2 his SpO2 (right hand) is 79%. Heart rate is 128/min, respirations are 58/min. After raising the FIO2 to 40%, which of the following additional diagnostic information would you obtain or recommend? (SELECT AS MANY as you consider indicated in this Section, then click on the Go To Next Section button below to proceed to the next Section.) Requested Information: Data Arterial blood gas ph = 7.31; PaCO2 = 51 torr; HCO3 = 25 mmol/l; BE = -1.0; PaO2 = 45 torr; SaO2 = 81% (40% O2) Chest transillumination Not performed -1 Echocardiogram Pending +2 Neonatal Behavioral Assessment Not performed -2 (Brazelton) Hyperoxia test PaO2 on 100% O2 = 138 torr +1 General inspection/appearance Central cyanosis and intercostal retractions persist, now accompanied by xiphoid retractions and expiratory grunting +2 Pre-/post-ductal SpO2s Pre = 81%; post = 81% (40% O2) +2 Breath sounds Diminished bilaterally +1 Chest X-ray Pending +2 Crying vital capacity Not performed -1 Perfect Score: 12 Minimum Pass Score: 10 Score +2 5
6 Decision-Making Section Simulation Section #: 4 Links from Section #: 3 Links to Section #(s): 5 The chest X-ray indicates reduced lung volume with diffuse reticulogranular appearance and air bronchograms. Echocardiogram indicates patent ductus arteriosus (PDA) with moderate systolic left-to-right shunting, no other structural defects noted. Which of the following would you recommend at this time? (CHOOSE ONLY ONE unless you are directed to Make another ) Action/Recommendation Link to Score Section Intubation and pressure control SIMV Physician disagrees. Make another -2 Surfactant replacement therapy Physician agrees +2 5 Immediate surgery to correct the Physician disagrees. Make another -2 PDA Intubation and volume control A/C Physician disagrees. Make another -2 ventilation Nasal CPAP with 50% O2 Physician agrees Perfect Score: +2 Minimum Pass Score: 1 6
7 Decision-Making Section Simulation Section #: 5 Links from Section #: 4 Links to Section #(s): End The infant s physician decides to proceed with surfactant replacement therapy. Which of the following methods would you recommend for administration? (CHOOSE ONLY ONE unless you are directed to Make another ) Action/Recommendation Place infant in head-down position, administer surfactant via aerosol, then place on nasal CPAP Instill surfactant into pharynx, half dose each with infant in right and left lateral positions, then apply positive pressure via mask Intubate, instill surfactant through ET tube with infant in supine position, extubate to nasal CPAP Intubate, instill surfactant via bronchoalveolar lavage with infant in supine position, then place on CPAP Instill surfactant into pharynx with infant in Fowler s position, then intubate and place on pressure control ventilation Physician disagrees. Make another Physician disagrees. Make another Score -1-2 Link to Section Physician agrees. +2 End Physician agrees. +1 End Physician disagrees. Make another Perfect Score: 2 Minimum Pass Score: 1-2 7
8 RTBoardReview Simulation 08 Cyanotic Preterm Infant in Respiratory Distress Condition/Diagnosis: Neonatal Respiratory Distress Syndrome Simulation Scoring Individual Scoring (Used for All RTBoardReview Simulations) Score Meaning +2 Essential/optimum to identifying or resolving problem +1 Likely helpful in identifying or resolving problem 0 Neither helpful nor harmful in identifying or resolving problem -1 Unnecessary or potentially harmful in identifying or resolving problem -2 Wastes critical time in identifying problem or causes direct harm to patient -3 Results in life-threatening harm to patient Summary Scoring of Simulation 08 Section IG Max IG Min DM Max DM Min TOTALS MPL% 78% 66% Cut Score = IG Min + DM Min = = 22 MPL% = Minimum Pass Level as a percent = (Min/Max) x 100 IG and DM MPL% vary by problem; typically ranges are 77-81% for IG and 60-70% for DM If the IG or DM raw score is negative (e.g., -2) then the reported % score = 0 The Cut Score for a problem is the sum of IG Min + DM min To pass a problem, the sum of one s IG + DM raw scores must be the Cut Score 8
9 Take-Home Points RTBoardReview Simulation 08 Cyanotic Preterm Infant in Respiratory Distress Condition/Diagnosis: Neonatal Respiratory Distress Syndrome Assessment/Information Gathering Assess the history and look for evidence of prematurity (<37 weeks gestation), low birth weight (< 1500 g) and related maternal risk factors such as diabetes. Assess for lecithin/sphingomyelin (L/S) ratio (< 2) and absence of phosphatidyl glycerol as indicators of pulmonary immaturity. Observe for progressive respiratory distress shortly after birth, including tachypnea (> 60/min), subcostal and intercostal retractions, expiratory grunting, decreased breath sounds, nasal flaring, and cyanosis in room air (signs may not appear for a few hours). Recommend chest X-ray looking for low lung volume with diffuse reticulogranular ("ground-glass") appearance and air bronchograms. Recommend ABG, looking for respiratory acidosis with severe hypoxemia (P/F < 200). Differential Dx: meconium aspiration, pneumonia, congenital diaphragmatic hernia, cyanotic heart disease, persistent fetal circulation, transient tachypnea of the newborn. Recommend appropriate cultures to rule out an infection, e.g., pneumonia or sepsis. Recommend hyperoxia test and/or pre-/post-ductal SpO2 screening to rule out a critical congenital heart defect (CCHD) as the cause of the cyanosis and respiratory distress. Recommend an echocardiogram if extrapulmonary shunting is suspected, e.g. a PDA. Treatment/Decision-Making For women at risk of giving birth between weeks 24 to 34 of pregnancy, recommend corticosteroid administration prior to birth ("antenatal steroids" enhance lung maturation and reduces risk of RDS, brain hemorrhage and death). Maintain a neutral thermal environment via incubator or radiant warmer. Provide sufficient O2 to maintain a PaO2 between torr or SpO2 between 85-92%. For spontaneously breathing infants with clinical findings indicating RDS, implement early prophylactic surfactant therapy using the INSURE ("INtubation-SURfactant- Extubation ) approach, i.e., brief intubation after birth, surfactant administration, then immediate extubation to 4 to 6 cm H2O nasal CPAP or high flow cannula at 1-6 L/min. Recommend intubation and mechanical ventilation for any infant 27 gestational age whose mother did not receive antenatal steroids or if the infant: o is apneic or o is unable to maintain an adequate airway or o exhibits increased work of breathing (grunting, retractions, flaring) on CPAP or o cannot maintain a ph > 7.25 on CPAP To avoid volutrauma during mechanical ventilation, apply volume-controlled or volumetargeted ventilation with low tidal volumes (4-5 ml/kg) and let the PaCO2 rise as long as the ph remains > 7.20, i.e., permissive hypercapnia 9
10 Aim for early extubation to nasal CPAP when: o The infant exhibits adequate respiratory drive o Mean airway pressure are 7 cm H2O o Satisfactory oxygenation can be maintained on 35% O2 Do not recommend high-frequency ventilation (no benefit over conventional ventilation). Do not recommend inhaled nitric oxide (INO) therapy unless the IRDS is accompanied by PPHN. Follow-up Resources Standard Text Resources: Des Jardins, T, & Burton, GG. (2011). Respiratory Distress Syndrome. (Chapter 34). In Clinical Manifestations and Assessment of Respiratory Disease, 6th Ed. Maryland Heights, MO: Mosby- Elsevier. Useful Web Links: American Association for Respiratory Care. (2013). Clinical Practice Guideline. Surfactant Replacement Therapy. Respir Care, 58, Brown, MK & DiBlasi, RM. (2011). Mechanical ventilation of the premature neonate. Respir Care, 56, Centers for Disease Control and Prevention. (2103). Screening for Critical Congenital Heart Defects. European Consensus Guidelines on the Management of Neonatal Respiratory Distress Syndrome in Preterm Infants 2013 Update. (2013). Neonatology, 103, onat2013.pdf Hermansen, CL, Lorah, KN. (2007). Respiratory Distress in the Newborn. Am Fam Physician. 76, Pramanik, AK. (2012). Respiratory Distress Syndrome. Medscape/E-Medicine. Available at: Wheeler, KI, et al. (2011). Volume-targeted versus pressure-limited ventilation for preterm infants: a systematic review and meta-analysis. Neonatology, 100,
Simulation 3: Post-term Baby in Labor and Delivery
Simulation 3: Post-term Baby in Labor and Delivery Opening Scenario (Links to Section 1) You are an evening-shift respiratory therapist in a large hospital with a level III neonatal unit. You are paged
More informationSimulation 01: Two Year-Old Child in Respiratory Distress (Croup)
Simulation 01: Two Year-Old Child in Respiratory Distress (Croup) Flow Chart Opening Scenario 2 year-old child in respiratory distress - assess Section 1 Type: IG audible stridor with insp + exp wheezing;
More informationSimulation 1: Two Year-Old Child in Respiratory Distress
Simulation 1: Two Year-Old Child in Respiratory Distress Opening Scenario (Links to Section 1) You are the respiratory therapist in a 300 bed community hospital working the evening shift. At 8:30 PM you
More informationHyaline membrane disease. By : Dr. Ch Sarishma Peadiatric Pg
Hyaline membrane disease By : Dr. Ch Sarishma Peadiatric Pg Also called Respiratory distress syndrome. It occurs primarily in premature infants; its incidence is inversely related to gestational age and
More informationReview of Neonatal Respiratory Problems
Review of Neonatal Respiratory Problems Respiratory Distress Occurs in about 7% of infants Clinical presentation includes: Apnea Cyanosis Grunting Inspiratory stridor Nasal flaring Poor feeding Tachypnea
More informationSimulation 15: 51 Year-Old Woman Undergoing Resuscitation
Simulation 15: 51 Year-Old Woman Undergoing Resuscitation Flow Chart Flow Chart Opening Scenario Section 1 Type: DM Arrive after 5-6 min in-progress resuscitation 51 YO female; no pulse or BP, just received
More information1st Annual Clinical Simulation Conference
1st Annual Clinical Simulation Conference Newborns with Acute Respiratory Distress: Diagnosis and Management Ma Teresa C. Ambat, MD Assistant Professor Division of Neonatology, Department of Pediatrics
More informationGuidelines and Best Practices for Vapotherm High Velocity Nasal Insufflation (Hi-VNI ) NICU POCKET GUIDE
Guidelines and Best Practices for Vapotherm High Velocity Nasal Insufflation (Hi-VNI ) TM NICU POCKET GUIDE Patient Selection Diagnoses Patient presents with one or more of the following symptoms: These
More informationProvide guidelines for the management of mechanical ventilation in infants <34 weeks gestation.
Page 1 of 5 PURPOSE: Provide guidelines for the management of mechanical ventilation in infants
More informationVolume Guarantee Initiation and ongoing clinical management of an infant supported by Volume Guarantee A Case Study
D-32084-2011 Volume Guarantee Initiation and ongoing clinical management of an infant supported by Volume Guarantee A Case Study Robert DiBlasi RRT-NPS, FAARC Respiratory Care Manager of Research & Quality
More informationSimulation 05: 41 Year-Old Female with Muscle Weakness and Dyspnea
Simulation 05: 41 Year-Old Female with Muscle Weakness and Dyspnea Flow Chart Opening Scenario 41 year-old female admitted 3 days ago with fever, myalgia, and a nonproductive cough after a bout of flu
More informationSimulation 04: 28 Year-Old Male in Respiratory Distress (Asthma)
Simulation 04: 28 Year-Old Male in Respiratory Distress (Asthma) Flow Chart Opening Scenario 28 year-old man in respiratory distress - assess Section 1 Type: IG Anxious pt with asthma history; insp + exp
More informationNeonatal/Pediatric Cardiopulmonary Care. Persistent Pulmonary Hypertension of the Neonate (PPHN) PPHN. Other. Other Diseases
Neonatal/Pediatric Cardiopulmonary Care Other Diseases Persistent Pulmonary Hypertension of the Neonate (PPHN) PPHN 3 Also known as Persistent Fetal Circulation (PFC) Seen most frequently in term, post-term
More information5. What is the cause of this patient s metabolic acidosis? LACTIC ACIDOSIS SECONDARY TO ANEMIC HYPOXIA (HIGH CO LEVEL)
Self-Assessment RSPT 2350: Module F - ABG Analysis 1. You are called to the ER to do an ABG on a 40 year old female who is C/O dyspnea but seems confused and disoriented. The ABG on an FiO 2 of.21 show:
More informationSurfactant Administration
Approved by: Surfactant Administration Gail Cameron Senior Director Operations, Maternal, Neonatal & Child Health Programs Dr. Paul Byrne Medical Director, Neonatology Neonatal Policy & Procedures Manual
More informationUsefulness of DuoPAP in the treatment of very low birth weight preterm infants with neonatal respiratory distress syndrome
European Review for Medical and Pharmacological Sciences 2015; 19: 573-577 Usefulness of DuoPAP in the treatment of very low birth weight preterm infants with neonatal respiratory distress syndrome B.
More informationCONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEFINITION
CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEFINITION Method of maintaining low pressure distension of lungs during inspiration and expiration when infant breathing spontaneously Benefits Improves oxygenation
More informationPresented By : Kamlah Olaimat
Presented By : Kamlah Olaimat 18\7\2010 Transient Tachpnea of the Definition:- newborn (TTN) TTN is a benign disease of near term or term infant who display respiratory distress shortly after delivery.
More informationNeonatal/Pediatric Cardiopulmonary Care
Neonatal/Pediatric Cardiopulmonary Care Resuscitation 2 When To Resuscitate Need usually related Combination of Can occur in 3 Causes of Fetal Asphyxia 1 4 Apnea Hypoxia Stimulates chemoreceptors & baroreceptors
More informationThe Blue Baby. Network Stabilisation of the Term Infant Study Day 15 th March 2017 Joanna Behrsin
The Blue Baby Network Stabilisation of the Term Infant Study Day 15 th March 2017 Joanna Behrsin Session Structure Definitions and assessment of cyanosis Causes of blue baby Structured approach to assessing
More informationBPD. Neonatal/Pediatric Cardiopulmonary Care. Disease. Bronchopulmonary Dysplasia. Baby Jane
1 Neonatal/Pediatric Cardiopulmonary Care Disease 2 Bronchopulmonary Dysplasia 3 is a 33-day-old prematurely born girl who weighs 1420 g. At birth, her estimated gestational age was 28 weeks. Her initial
More information5 Million neonatal deaths each year worldwide. 20% caused by neonatal asphyxia. Improvement of the outcome of 1 million newborns every year
1 5 Million neonatal deaths each year worldwide 20% caused by neonatal asphyxia Improvement of the outcome of 1 million newborns every year International Liaison Committee on Resuscitation (ILCOR) American
More informationCPAP failure in preterm infants: incidence, predictors and consequences
CPAP failure in preterm infants: incidence, predictors and consequences SUPPLEMENTAL TEXT METHODS Study setting The Royal Hobart Hospital has an 11-bed combined Neonatal and Paediatric Intensive Care Unit
More informationNEONATOLOGY Healthy newborn. Neonatal sequelaes
NEONATOLOGY Healthy newborn. Neonatal sequelaes Ágnes Harmath M.D. Ph.D. senior lecturer 11. November 2016. Tasks of the neonatologist Prenatal diagnosed condition Inform parents, preparation of necessary
More informationTRAINING NEONATOLOGY SILVANA PARIS
TRAINING ON NEONATOLOGY SILVANA PARIS RESUSCITATION IN DELIVERY ROOM INTRODUCTION THE GLOBAL RESUSCITATION BURDEN IN NEWBORN 136 MILL NEWBORN BABIES EACH YEAR (WHO WORLD REPORT) 5-8 MILL NEWBORN INFANTS
More informationACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) Rv
ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) Rv.8.18.18 ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) SUDDEN PROGRESSIVE FORM OF ACUTE RESPIRATORY FAILURE ALVEOLAR CAPILLARY MEMBRANE BECOMES DAMAGED AND MORE
More informationMODULE VII. Delivery and Immediate Neonatal Care
MODULE VII Delivery and Immediate Neonatal Care NEONATAL ASPHYXIA About one million deaths per year In Latin America 12% of newborns suffer some degree of asphyxia Main cause of perinatal and neonatal
More informationAdmission/Discharge Form for Infants Born in Please DO NOT mail or fax this form to the CPQCC Data Center. This form is for internal use ONLY.
Selection Criteria Admission/Discharge Form for Infants Born in 2016 To be eligible, you MUST answer YES to at least one of the possible criteria (A-C) A. 401 1500 grams o Yes B. GA range 22 0/7 31 6/7
More informationScreening for Critical Congenital Heart Disease
Screening for Critical Congenital Heart Disease Caroline K. Lee, MD Pediatric Cardiology Disclosures I have no relevant financial relationships or conflicts of interest 1 Most Common Birth Defect Most
More informationNeonatal Life Support Provider (NLSP) Certification Preparatory Materials
Neonatal Life Support Provider (NLSP) Certification Preparatory Materials NEONATAL LIFE SUPPORT PROVIDER (NRP) CERTIFICATION TABLE OF CONTENTS NEONATAL FLOW ALGORITHM.2 INTRODUCTION 3 ANTICIPATION OF RESUSCITATION
More informationPractical Application of CPAP
CHAPTER 3 Practical Application of CPAP Dr. Srinivas Murki Neonatologist Fernadez Hospital, Hyderabad. A.P. Practical Application of CPAP Continuous positive airway pressure (CPAP) applied to premature
More informationArabian Gulf University Kingdom of Bahrain Year 5 Pediatrics 3 rd Week Discussion with Dr. Muna Al-Jufairi (Part 2)
Arabian Gulf University Kingdom of Bahrain Year 5 Pediatrics 3 rd Week Discussion with Dr. Muna Al-Jufairi (Part 2) - Case 1: a 32 weeks preterm developed RDS 4 hours after delivery. Chest X-ray shows:
More informationWhen is Risky to Apply Oxygen for Congenital Heart Disease 부천세종병원 소아청소년과최은영
When is Risky to Apply Oxygen for Congenital Heart Disease 부천세종병원 소아청소년과최은영 The Korean Society of Cardiology COI Disclosure Eun-Young Choi The author have no financial conflicts of interest to disclose
More informationNeonatal Resuscitation. Dustin Coyle, M.D. Anesthesiology
Neonatal Resuscitation Dustin Coyle, M.D. Anesthesiology Recognize complications Maternal-fetal factors Maternal DM PIH Chronic HTN Previous stillbirth Rh sensitization Infection Substance abuse/certain
More information** SURFACTANT THERAPY**
** SURFACTANT THERAPY** Full Title of Guideline: Surfactant Therapy Author (include email and role): Stephen Wardle (V4) Reviewed by Dushyant Batra Consultant Neonatologist Division & Speciality: Division:
More informationARDS: an update 6 th March A. Hakeem Al Hashim, MD, FRCP SQUH
ARDS: an update 6 th March 2017 A. Hakeem Al Hashim, MD, FRCP SQUH 30M, previously healthy Hx: 1 week dry cough Gradually worsening SOB No travel Hx Case BP 130/70, HR 100/min ph 7.29 pco2 35 po2 50 HCO3
More informationBubble CPAP for Respiratory Distress Syndrome in Preterm Infants
R E S E A R C H P A P E R Bubble CPAP for Respiratory Distress Syndrome in Preterm Infants JAGDISH KOTI*, SRINIVAS MURKI, PRAMOD GADDAM, ANUPAMA REDDY AND M DASARADHA RAMI REDDY From Fernandez Hospital
More informationAn Overview of Bronchopulmonary Dysplasia and Chronic Lung Disease in Infancy
An Overview of Bronchopulmonary Dysplasia and Chronic Lung Disease in Infancy Housekeeping: I have no financial disclosures Learning objectives: Develop an understanding of bronchopulmonary dysplasia (BPD)
More informationGuidelines and Best Practices for High Flow Nasal Cannula (HFNC) Pediatric Pocket Guide
Guidelines Best Practices for High Flow Nasal Cannula (HFNC) Pediatric Pocket Guide Patient Selection Diagnoses Patient presents with one or more of the following signs or symptoms of respiratory distress:
More informationNEONATAL LIFE SUPPORT PROVIDER (NLSP) CERTIFICATION EXAMINATION 1. To determine if an infant requires resuscitation, you must rapidly assess gestation period, presence of meconium in amniotic fluid, breaths
More informationB13. Baby s Breath: Ventilation Strategies and Blood Gas Interpretation. Session Summary. Session Objectives. Test Questions.
B13 Baby s Breath: Ventilation Strategies and Blood Gas Interpretation Karen Wright, PhD, NNP-BC DNP NNP Program Director Rush University, Chicago, IL The speaker has signed a disclosure form and indicated
More informationLecture Notes. Chapter 2: Introduction to Respiratory Failure
Lecture Notes Chapter 2: Introduction to Respiratory Failure Objectives Define respiratory failure, ventilatory failure, and oxygenation failure List the causes of respiratory failure Describe the effects
More informationSimulation 02: 60 Year-Old Man with Wheezing, Hypoxemia (Congestive Heart Failure with Pulmonary Edema) Flow Chart
Simulation 02: 60 Year-Old Man with Wheezing, Hypoxemia (Congestive Heart Failure with Pulmonary Edema) Flow Chart Opening Scenario Section 1 Type: IG Section 2 Type: DM Section 3 Type: IG 60 year-old
More informationThe Turkish Journal of Pediatrics 2014; 56:
The Turkish Journal of Pediatrics 2014; 56: 232-237 Original INSURE method (INtubation-SURfactant-Extubation) in early and late premature neonates with respiratory distress: factors affecting the outcome
More information1
1 2 3 RIFAI 5 6 Dublin cohort, retrospective review. Milrinone was commenced at an initial dose of 0.50 μg/kg/minute up to 0.75 μg/kg/minute and was continued depending on clinical response. No loading
More informationNoah Hillman M.D. IPOKRaTES Conference Guadalajaira, Mexico August 23, 2018
Postnatal Steroids Use for Bronchopulmonary Dysplasia in 2018 + = Noah Hillman M.D. IPOKRaTES Conference Guadalajaira, Mexico August 23, 2018 AAP Policy Statement - 2002 This statement is intended for
More informationROLE OF EARLY POSTNATAL DEXAMETHASONE IN RESPIRATORY DISTRESS SYNDROME
INDIAN PEDIATRICS VOLUME 35-FEBRUAKY 1998 ROLE OF EARLY POSTNATAL DEXAMETHASONE IN RESPIRATORY DISTRESS SYNDROME Kanya Mukhopadhyay, Praveen Kumar and Anil Narang From the Division of Neonatology, Department
More informationMODULE VII. Delivery and Immediate Neonatal Care
MODULE VII Delivery and Immediate Neonatal Care NEONATAL ASPHYXIA About one million deaths per year In Latin America 12% of newborns suffer some degree of asphyxia A major cause of perinatal and neonatal
More informationHFOV Case Study 3.6kg MAS Instructor Copy
HFOV Case Study 3.6kg MAS Instructor Copy Color key: Black Patient case Blue RN/RCP collaboration Red MD consult Green - Critical Thinking Inquiry Green italics CT answers ABG: ph/pco2/po2/base A 35 year-old
More informationUSE OF INHALED NITRIC OXIDE IN THE NICU East Bay Newborn Specialists Guideline Prepared by P Joe, G Dudell, A D Harlingue Revised 7/9/2014
USE OF INHALED NITRIC OXIDE IN THE NICU East Bay Newborn Specialists Guideline Prepared by P Joe, G Dudell, A D Harlingue Revised 7/9/2014 ino for Late Preterm and Term Infants with Severe PPHN Background:
More informationSWISS SOCIETY OF NEONATOLOGY. Supercarbia in an infant with meconium aspiration syndrome
SWISS SOCIETY OF NEONATOLOGY Supercarbia in an infant with meconium aspiration syndrome January 2006 2 Wilhelm C, Frey B, Department of Intensive Care and Neonatology, University Children s Hospital Zurich,
More information7/4/2015. diffuse lung injury resulting in noncardiogenic pulmonary edema due to increase in capillary permeability
Leanna R. Miller, RN, MN, CCRN-CMC, PCCN-CSC, CEN, CNRN, CMSRN, NP Education Specialist LRM Consulting Nashville, TN Objectives Identify the 5 criteria for the diagnosis of ARDS. Discuss the common etiologies
More informationSARASOTA MEMORIAL HOSPITAL NURSING PROCEDURE
SARASOTA MEMORIAL HOSPITAL TITLE: NURSING PROCEDURE Management, Monitoring & Documentation of a Clinically Significant Cardiopulmonary Event (CSCPE) (NUR47) DATE: REVIEWED: PAGES: 9/09 9/17 1 of 6 PS1094
More informationKugelman A, Riskin A, Said W, Shoris I, Mor F, Bader D.
Heated, Humidified High-Flow Nasal Cannula (HHHFNC) vs. Nasal Intermittent Positive Pressure Ventilation (NIPPV) for the Primary Treatment of RDS, A Randomized, Controlled, Prospective, Pilot Study Kugelman
More informationPROFESSOR DR. NUMAN NAFIE HAMEED الاستاذ الدكتور نعمان نافع الحمداني
Lecture 6 PROFESSOR DR. NUMAN NAFIE HAMEED الاستاذ الدكتور نعمان نافع الحمداني Neonatal Resuscitation Program (NRP) 2010 MCQ? In neonatal resuscitation program, the preterm neonates need special preparations
More informationNeonatal Resuscitation in What is new? How did we get here? Steven Ringer MD PhD Harvard Medical School May 25, 2011
Neonatal Resuscitation in 2011- What is new? How did we get here? Steven Ringer MD PhD Harvard Medical School May 25, 2011 Conflicts I have no actual or potential conflict of interest in relation to this
More informationInfection. Risk factor for infection ACoRN alerting sign with * Clinical deterioration. Problem List. Respiratory. Cardiovascular
The ACoRN Process Baby at risk Unwell Risk factors Post-resuscitation requiring stabilization Resuscitation Ineffective breathing Heart rate < 100 bpm Central cyanosis Support Infection Risk factor for
More informationDr. (Kate) Katherine Miller GUELPH ON 121 RESPIRATORY DISTRESS IN THE NEWBORN
Society of Rural Physicians of Canada 26TH ANNUAL RURAL AND REMOTE MEDICINE COURSE ST. JOHN'S NEWFOUNDLAND AND LABRADOR APRIL 12-14, 2018 Dr. (Kate) Katherine Miller GUELPH ON 121 RESPIRATORY DISTRESS
More informationADMISSION/DISCHARGE FORM FOR INFANTS BORN IN 2019 DO NOT mail or fax this form to the CPQCC Data Center. This form is for internal use ONLY.
1 Any eligible inborn infant who dies in the delivery room or at any other location in your hospital within 12 hours after birth and prior to admission to the NICU is defined as a "Delivery Room Death."
More informationRespiratory Disorders in the Newborn: Identification and Diagnosis Hany Aly. DOI: /pir
Respiratory Disorders in the Newborn: Identification and Diagnosis Hany Aly Pediatr. Rev. 2004;25;201-208 DOI: 10.1542/pir.25-6-201 The online version of this article, along with updated information and
More informationPulmonary Problems of the Neonate. Jon Palmer, VMD, DACVIM Chief, Neonatal Intensive Care Service New Bolton Center, University of Pennsylvania, USA
Pulmonary Problems of the Neonate Jon Palmer, VMD, DACVIM Chief, Neonatal Intensive Care Service New Bolton Center, University of Pennsylvania, USA Lower Respiratory Diseases Ventilation/Perfusion Abnormalities
More informationNRP Raising the Bar for Providers and Instructors
NRP 2011 Raising the Bar for Providers and Instructors What is the same? 1. Minimum course requirement is Lessons 1 through 4 and Lesson 9. The NRP Provider Card requires renewal every 2 years. Your facility
More informationINTRODUCTION The effect of CPAP works on lung mechanics to improve oxygenation (PaO 2
2 Effects of CPAP INTRODUCTION The effect of CPAP works on lung mechanics to improve oxygenation (PaO 2 ). The effect on CO 2 is only secondary to the primary process of improvement in lung volume and
More informationPulse Oximetry Screening in Newborns to Enhance the Detection Of Critical Congenital Heart Disease. Frequently Asked Questions
Pulse Oximetry Screening in Newborns to Enhance the Detection Of Critical Congenital Heart Disease Frequently Asked Questions Current Recommendation: The current recommendation from the Canadian Cardiovascular
More informationLung Wit and Wisdom. Understanding Oxygenation and Ventilation in the Neonate. Jennifer Habert, BHS-RT, RRT-NPS, C-NPT Willow Creek Women s Hospital
Lung Wit and Wisdom Understanding Oxygenation and Ventilation in the Neonate Jennifer Habert, BHS-RT, RRT-NPS, C-NPT Willow Creek Women s Hospital Objectives To review acid base balance and ABG interpretation
More informationAEROSURF Phase 2 Program Update Investor Conference Call
AEROSURF Phase 2 Program Update Investor Conference Call November 12, 2015 Forward Looking Statement To the extent that statements in this presentation are not strictly historical, including statements
More informationNAVA. In Neonates. Howard Stein, M.D. Director Neonatology. Neurally Adjusted Ventilatory Assist. Toledo Children s Hospital Toledo, Ohio
NAVA Neurally Adjusted Ventilatory Assist In Neonates Howard Stein, M.D. Director Neonatology Toledo Children s Hospital Toledo, Ohio Disclaimers Dr Stein: Is discussing products made by Maquet Has no
More informationName and title of the investigators responsible for conducting the research: Dr Anna Lavizzari, Dr Mariarosa Colnaghi
Protocol title: Heated, Humidified High-Flow Nasal Cannula vs Nasal CPAP for Respiratory Distress Syndrome of Prematurity. Protocol identifying number: Clinical Trials.gov NCT02570217 Name and title of
More informationNeonatal Resuscitation
Neonatal Resuscitation High Risk Deliveries A person trained in neonatal resuscitation is usually called to be present for the following deliveries: 1. Antepartum factors Maternal diabetes Pregnancy induced
More informationSample Case Study. The patient was a 77-year-old female who arrived to the emergency room on
Sample Case Study The patient was a 77-year-old female who arrived to the emergency room on February 25 th with a chief complaint of shortness of breath and a deteriorating pulmonary status along with
More informationTable 1: The major changes in AHA / AAP neonatal resuscitation guidelines2010 compared to previous recommendations in 2005
Table 1: The major changes in AHA / AAP neonatal guidelines2010 compared to previous recommendations in 2005 Resuscitation step Recommendations (2005) Recommendations (2010) Comments/LOE 1) Assessment
More informationObjectives. Apnea Definition and Pitfalls. Pathophysiology of Apnea. Apnea of Prematurity and hypoxemia episodes 5/18/2015
Apnea of Prematurity and hypoxemia episodes Deepak Jain MD Care of Sick Newborn Conference May 2015 Objectives Differentiating between apnea and hypoxemia episodes. Pathophysiology Diagnosis of apnea and
More informationReceived: Jun 15, 2013; Accepted: Nov 08, 2013; First Online Available: Jan 24, 2014
Original Article Iran J Pediatr Feb 2014; Vol 24 (No 1), Pp: 57-63 Management of Neonatal Respiratory Distress Syndrome Employing ACoRN Respiratory Sequence Protocol versus Early Nasal Continuous Positive
More informationImages have been removed from the PowerPoint slides in this handout due to copyright restrictions.
Arterial Blood Gas Interpretation Routine Assessment Inspection Palpation Auscultation Labs Na 135-145 K 3.5-5.3 Chloride 95-105 CO2 22-31 BUN 10-26 Creat.5-1.2 Glu 80-120 Arterial Blood Gases WBC 5-10K
More informationA radiological perspective of assessing neonatal respiratory distress syndrome
Original Research Article A radiological perspective of assessing neonatal respiratory distress syndrome Jayesh Shah 1, Nikhil Parvatkar 2*, C. Raychaudhuri 3 1 Associate Professor, 2 1 st Year Resident,
More informationNon Invasive Ventilation In Preterm Infants. Manuel Sanchez Luna Hospital General Universitario Gregorio Marañón Complutense University Madrid
Non Invasive Ventilation In Preterm Infants Manuel Sanchez Luna Hospital General Universitario Gregorio Marañón Complutense University Madrid Summary Noninvasive ventilation begings in the delivery room
More informationSteven Ringer MD PhD April 5, 2011
Steven Ringer MD PhD April 5, 2011 Disclaimer Mead Johnson sponsors programs such as this to give healthcare professionals access to scientific and educational information provided by experts. The presenter
More informationApproach to a baby with cyanosis
Approach to a baby with cyanosis Objectives Cyanosis : types Differentials: cardiac vs. non cardiac Approach Case scenarios Cyanosis Greek word kuaneos meaning dark blue Bluish discolouration of skin,
More informationDAYTON CHILDREN S HOSPITAL CLINICAL PRACTICE GUIDELINES
DAYTON CHILDREN S HOSPITAL CLINICAL PRACTICE GUIDELINES DISCLAIMER: This Clinical Practice Guideline (CPG) generally describes a recommended course of treatment for patients with the identified health
More informationHFOV IN THE NON-RECRUITABLE LUNG
HFOV IN THE NON-RECRUITABLE LUNG HFOV IN THE NON-RECRUITABLE LUNG PPHN Pulmonary hypoplasia after PPROM Congenital diaphragmatic hernia Pulmonary interstitial emphysema / cystic lung disease 1 30 Mean
More informationAddendum to the NRP Provider Textbook 6 th Edition Recommendations for specific modifications in the Canadian context
Addendum to the NRP Provider Textbook 6 th Edition Recommendations for specific modifications in the Canadian context A subcommittee of the Canadian Neonatal Resuscitation Program (NRP) Steering Committee
More informationCardiovascular Pathophysiology: Right to Left Shunts aka Cyanotic Lesions
Cardiovascular Pathophysiology: Right to Left Shunts aka Cyanotic Lesions Ismee A. Williams, MD, MS iib6@columbia.edu Pediatric Cardiology Learning Objectives To discuss the hemodynamic significance of
More informationCardiovascular Pathophysiology: Right to Left Shunts aka Cyanotic Lesions Ismee A. Williams, MD, MS Pediatric Cardiology
Cardiovascular Pathophysiology: Right to Left Shunts aka Cyanotic Lesions Ismee A. Williams, MD, MS iib6@columbia.edu Pediatric Cardiology Learning Objectives To discuss the hemodynamic significance of
More informationBlood Gases / Acid-Base
Blood Gases / Acid-Base Neonatal Ventilation Workshop June 2010 Dr. Julian Eason Consultant Neonatologist Why are blood gases performed? Diagnostic assessment of oxygenation capacity of lungs Therapeutic
More informationPROCEDURE (TASK): CONTINUOUS DISTENDING PRESSURE THERAPY (CPAP) (NEONATAL/PEDIATRICS)
PROCEDURE (TASK): CONTINUOUS DISTENDING PRESSURE THERAPY (CPAP) (NEONATAL/PEDIATRICS) I. KEY PERFORMANCE ELEMENTS Procedural Element (Step): Description of Satisfactory Performance: 5. Obtains baseline
More informationDuct Dependant Congenital Heart Disease
Children s Acute Transport Service Clinical Guidelines Duct Dependant Congenital Heart Disease This guideline has been agreed by both NTS & CATS Document Control Information Author CATS/NTS Author Position
More informationACoRN Workbook 2012 Update
ACoRN Neonatal Society Société néonatale ACoRN www.acornprogram.net A Canadian non-profit Society Vancouver, British Columbia ACoRN Workbook 2012 Update Name: The ACoRN Process The Resuscitation Sequence
More informationWe are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors
We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 3,800 116,000 120M Open access books available International authors and editors Downloads Our
More informationHow to Recognize a Suspected Cardiac Defect in the Neonate
Neonatal Nursing Education Brief: How to Recognize a Suspected Cardiac Defect in the Neonate https://www.seattlechildrens.org/healthcareprofessionals/education/continuing-medical-nursing-education/neonatalnursing-education-briefs/
More informationStabilization of the Newborn for Transport. Relevant Disclosure. Learning Objectives
Stabilization of the Newborn for Transport Arlen Foulks, DO FAAP FACOP Medical Director, CCMH Level II NICU Medical Director, NeoFlight Assistant Professor of Pediatrics Neonatal Perinatal Medicine Section,
More informationLife Science Journal 2015;12(4)
Efficacy of elected Chest Physical Therapy on Neonates with Respiratory Distress yndrome Amira M. El-Tohamy 1, Ola. Darwish 2 and El-ayed. alem 3. 1 Professor of Physical Therapy for Growth and Development
More informationPrepared by : Bayan Kaddourah RN,MHM. GICU Clinical Instructor
Mechanical Ventilation Prepared by : Bayan Kaddourah RN,MHM. GICU Clinical Instructor 1 Definition Is a supportive therapy to facilitate gas exchange. Most ventilatory support requires an artificial airway.
More informationNitric Resource Manual
Nitric Resource Manual OBJECTIVES Describe the biologic basis for inhaled nitric oxide therapy Describe the indications for inhaled nitric oxide therapy Describe the potential hazards, side effects and
More informationWanchai Wongkornrat Cardiovascular Thoracic Surgery Siriraj Hospital Mahidol University
Wanchai Wongkornrat Cardiovascular Thoracic Surgery Siriraj Hospital Mahidol University Assess adequacy of ventilation and oxygenation Aids in establishing a diagnosis and severity of respiratory failure
More informationEmergency Medicine High Velocity Nasal Insufflation (Hi-VNI) VAPOTHERM POCKET GUIDE
Emergency Medicine High Velocity Nasal Insufflation (Hi-VNI) VAPOTHERM POCKET GUIDE Indications for Vapotherm High Velocity Nasal Insufflation (Hi-VNI ) administration, the patient should be: Spontaneously
More informationLecture Notes. Chapter 9: Smoke Inhalation Injury and Burns
Lecture Notes Chapter 9: Smoke Inhalation Injury and Burns Objectives List the factors that influence mortality rate Describe the nature of smoke inhalation and the fire environment Recognize the pulmonary
More informationTest Bank Pilbeam's Mechanical Ventilation Physiological and Clinical Applications 6th Edition Cairo
Instant dowload and all chapters Test Bank Pilbeam's Mechanical Ventilation Physiological and Clinical Applications 6th Edition Cairo https://testbanklab.com/download/test-bank-pilbeams-mechanical-ventilation-physiologicalclinical-applications-6th-edition-cairo/
More informationEquipment: NRP algorithm, MRSOPA table, medication chart, SpO 2 table Warm
NRP Skills Stations Performance Skills Station OR Integrated Skills Station STATION: Assisting with and insertion of endotracheal tube (ETT) Equipment: NRP algorithm, MRSOPA table, medication chart, SpO
More informationCongenital Heart Disease. CCCHD In WI. Critical Congenital Heart Disease. Why Screen? 4/20/2018. Early Detection = Better Outcomes
Congenital Heart Disease A Positive Screen? What Does it Mean? A Review of Pulse Oximetry Screening for Critical Congenital Heart Disease Elizabeth Goetz MD MPH 8-10/1000 livebirths 3% of all infant mortality
More information