it 28 - respiratory distress - jul
TRANSCRIPT
![Page 1: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/1.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 1/66
Visual 1
Respiratory Distress
Julniar M Tasli
Herman Bermawi
![Page 2: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/2.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 2/66
Objective
• To know the defnition o respiratory
distress• Must be able to obtain a complete
maternal and newborn history
•
Can perorm a through physicalexamination
• Recognie the common respiratorydisorders
• Can identiy those that are lie!treateningand rever them to the hospitals that havea "#C$ subdivison
![Page 3: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/3.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 3/66
%efniton
R% in the newborn is characteried by one ormore o the
ollowing &
! "asal 'aring
! Chest restriction & suprasternalsubcostal
intercostal
! Tachypnea! (runting
![Page 4: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/4.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 4/66
Evaluation
Is it a life threatening
event or illness?
Visual 4
![Page 5: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/5.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 5/66
#nitial )ssesment The aim o initial assesment o the inant in R% to identiy
lietreatening conditions that re*uire prompt support
+alarming or
R%, &
a- Obstructive airway& ! gasping
! choking
! stridor
b- #nsu.cient breathing & ! apnea
! poor respiratory e/ort
c- Circulatory collaps & ! bradycaria ! hipotension
! poor perusion
d- 0oor oxygenation & ! cyanosis
![Page 6: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/6.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 6/66
Evaluation of RespiratoryDistress Using Down’s
Score
1earning Objective 2 Visual 6
Audible with earAudible by
stethoscope
No gruntingGrunting
No air entryMild decrease in air
entry
Good bilateral air
entry
Air Entry
Cyanosis on O2Cyanosis relieed by
O2
No cyanosisCyanosis
!eere retractionsMild retractionsNo retraction"etractions
# $%&'in6% ( $%&'in) 6%&'in"espiratory "ate
21%
![Page 7: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/7.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 7/66
Evaluation of Respiratory
Distress Using Down’sScoreScore < 4 No respiratory distress
Score 4 ! Respiratory distress
Score " ! I#pending
respiratory failure $%loodgases should &e o&tained'
1earning Objective 2 Visual *
![Page 8: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/8.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 8/66
%e (repared
• Resuscitation e)uip#ent and*orsupplies
•
Involve others $tea# approach'• +ave sta, trained
• -%.
–
-irway – %reathing
– .irculation
Visual $
![Page 9: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/9.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 9/66
0hysical examination
#nspection & ! alarming sign urgent attention
! inspiratory stridor upper airway obstruction
! asymetric chest 3 severe distress tension
pneumothorax
! scaphoid abdomen & congenitaldiaphragmatic hernia
)uscultation & ! the symmetry and ade*uacy o airexchange
! abnormal breath sound
Transilumination o the chest
![Page 10: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/10.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 10/66
.onditions -ssociated with
Respiratory Distress4istory & Maternal
Obstertrical
5ymptom
Visual 1%
![Page 11: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/11.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 11/66
Visual 11
![Page 12: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/12.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 12/66
Differential diagnosis of respiratory distress
![Page 13: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/13.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 13/66
Investigations
• .hest /ray
• -rterial &lood gas
•
.%. $ane#ia0 polycythe#ia0sepsis'
• 1lucose chec2 $hypoglyce#ia'
•
%lood culture $sepsis0pneu#onia'
Visual 1+
![Page 14: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/14.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 14/66
3reat#ent
• -fter sta&iliation0 treat thecause of RD
• Use .(-(
• -void unnecessary e5posure too5ygen
•
-nti&iotics until sepsis is ruledout
Visual 14
![Page 15: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/15.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 15/66
.o##on .auses of RD.o##on .auses of RD
• 3ransient tachypnea of thenew&orn $33N'
• +yaline #e#&rane disease $+6D'
• 6econiu# aspiration syndro#e$6-S'
• -ir lea2 syndro#e
• (neu#onia
• .ongenital heart diseases
Visual 1,
![Page 16: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/16.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 16/66
3ransient 3achypnea of the3ransient 3achypnea of the
Neonate $33N'Neonate $33N'
De7nition
- &enign disease of nearter# orter# neonates who haverespiratory distress shortly afterdelivery that resolves within 89days:
1earning Objective 6 Visual 16
![Page 17: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/17.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 17/66
(athogenesis of 33N(athogenesis of 33N
• +ow is lung ;uid for#ed?
• hat is the function of lung;uids?
• hat happens to lung ;uidsduring la&or?
•
Does it #atter the type of la&or?
Visual 1*
![Page 18: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/18.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 18/66
3ransient 3achypnea of the3ransient 3achypnea of the
Neonate $33N' $cont'Neonate $33N' $cont'
Ris2 factors
•
.esarean section without la&or• 6acroso#ia
• 6ale se5
•
(rolonged la&or• E5cessive #aternal sedation
• =ow -pgar score $< ! at > #inute'
1earning Objective 6 Visual 1$
![Page 19: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/19.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 19/66
3ransient 3achypnea of the3ransient 3achypnea of the
Neonate $33N' $cont'Neonate $33N' $cont'
.linical (resentation of 33N
3he neonate is usually nearter# or
ter#0 and shortly after delivery hastachypnea $"@ &reaths*#inute': 3he
neonate #ay also have grunting0
nasal ;aring0 ri& retractions0 and
cyanosis: 3he disease usually does
not last longer than !A hours:
1earning Objective 6 Visual 1-
![Page 20: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/20.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 20/66
Visual 2%
![Page 21: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/21.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 21/66
3ransient 3achypnea of the3ransient 3achypnea of the
Neonate $33N' $cont'Neonate $33N' $cont'
–
.hest /rayB(erihilar strea2ing0 #ildcardio#egaly0 increased lungvolu#e0 ;uid in the #inor
7ssure0 and perhaps ;uid in thepleural space are co##on7ndings:
1earning Objective 6 Visual 21
![Page 22: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/22.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 22/66
3ransient 3achypnea of3ransient 3achypnea of
the Neonate $33N' $cont'the Neonate $33N' $cont'6anage#ent of 33N
•
Cudicious use of o5ygen• luid restriction• eeding as tachypnea i#proves .on7r# the diagnosis &y e5cluding
other causes of tachypnea e:g:pneu#onia0 congenital heart disease0hyaline #e#&rane disease0 andcere&ral hyperventilation:
1earning Objective 6 Visual 22
![Page 23: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/23.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 23/66
3ransient 3achypnea of the3ransient 3achypnea of the
Neonate $33N' $cont'Neonate $33N' $cont'
utco#e and (rognosis of 33N
3he disease is selfli#ited and thereis no ris2 of recurrence or furtherpul#onary dysfunction: Respiratory
sy#pto#s i#prove asintrapul#onary ;uid is #o&ilied0and this is usually associated withdiuresis:
1earning Objective 6 Visual 2+
+ li 6 & Di+ li 6 & Di
![Page 24: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/24.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 24/66
+yaline 6e#&rane Disease+yaline 6e#&rane Disease
$Respiratory Distress$Respiratory DistressSyndro#e'Syndro#e'
De7nition
+yaline #e#&rane disease $+6D' isalso called respiratory distresssyndro#e $RDS': 3his condition
usually occurs in a preter# neonate:(re#ature lungs are surfactantde7cient:
1earning Objective 7 Visual 24
![Page 25: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/25.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 25/66
+yaline 6e#&rane Disease+yaline 6e#&rane Disease
$Respiratory Distress$Respiratory Distress
Syndro#e'Syndro#e' $cont'$cont'
Respiratory diFculties e5hi&itedincludeB
• Increasing tachypnea $" G@*#in'
• .hest retractions
• .yanosis on roo# air that persists or
progresses over the 7rst A44 hoursof life:
• Decreased air entry• 1runting
1earning Objective 7 Visual 2,
![Page 26: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/26.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 26/66
+yaline 6e#&rane Disease+yaline 6e#&rane Disease
$Respiratory Distress$Respiratory DistressSyndro#e'Syndro#e' $cont'$cont'
Incidence
+6D occurs in a&out A9H ofneonates &orn at 8A wee2sgestation: 3he incidence
increases with increasingpre#aturity:
1earning Objective 7 Visual 26
![Page 27: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/27.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 27/66
+yaline 6e#&rane Disease
$Respiratory DistressSyndro#e' $cont'
Ris2 actors of
+6D
• Increased Ris2
– (re#aturity
– 6ale se5
– Neonate of dia&etic#other
1earning Objective 7 Visual 2*
![Page 28: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/28.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 28/66
+yaline 6e#&rane Disease
$Respiratory DistressSyndro#e' $cont'
Ris2 actors of +6D
• Decreased Ris2
– .hronic intrauterine stress• (rolonged rupture of #e#&ranes• 6aternal hypertension• Narcotic use• Intrauterine 1rowth Retardation
$IU1R' or S#all for 1estational -ge$S1-'
– .orticosteroids (renatal
1earning Objective 7 Visual 2$
![Page 29: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/29.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 29/66
+yaline 6e#&rane Disease+yaline 6e#&rane Disease
$Respiratory Distress$Respiratory DistressSyndro#e'Syndro#e' $cont'$cont'
Investigations for +6D $RDS'
•
=a&oratory StudiesB – %lood gasesB hypo5ia0 hypercar&ia0 acidosis:
– .%. and &lood culture are re)uired to rule out
infection:
– Seru# glucose levels are usually low:
• .hest /ray StudyB
– Reveals ground glass appearance with air
bronchograms-
1earning Objective 7 Visual 2-
![Page 30: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/30.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 30/66
Visual +%
![Page 31: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/31.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 31/66
+yaline 6e#&rane Disease+yaline 6e#&rane Disease
$Respiratory Distress$Respiratory Distress
Syndro#e'Syndro#e' $cont'$cont'
6anage#ent of +6D $RDS'
•
1eneral – 3her#al regulation
– (arenteral ;uid
– -nti&iotics
– .ontinuous #onitoring
1earning Objective 7 Visual +1
![Page 32: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/32.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 32/66
+yaline 6e#&rane Disease+yaline 6e#&rane Disease
$Respiratory Distress$Respiratory DistressSyndro#e'Syndro#e' $cont'$cont' – .ontinuous positive airway
pressure $.(-(' is tried:
– If under .(-(• (+ < !:A
• r (A < 4@##+g iA " G@H
• r (.A " G@##+
•
%ase de7cit " >@Endotracheal intu&ation and#echanical ventilation:
.onsider surfactant therapy1earning Objective 7 Visual +2
![Page 33: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/33.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 33/66
+yaline 6e#&rane Disease+yaline 6e#&rane Disease
$Respiratory Distress$Respiratory DistressSyndro#e'Syndro#e' $cont'$cont'
–.autionB every >@ days on
the ventilator is associatedwith A@H increased ris2 forcere&ral palsy
1earning Objective 7 Visual ++
![Page 34: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/34.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 34/66
+yaline 6e#&rane Disease+yaline 6e#&rane Disease
$Respiratory Distress$Respiratory DistressSyndro#e'Syndro#e' $cont'$cont'
• Speci7c 3reat#ent
– Surfactant replace#ent therapy iftracheal intu&ation is re)uired
• utco#e
– RDS accounts for A@H of all neonataldeaths
– .hronic lung diseases occurs in AJHin K=% infants
1earning Objective 7 Visual +4
![Page 35: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/35.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 35/66
Visual +,
![Page 36: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/36.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 36/66
6econiu# -spiration6econiu# -spiration
Syndro#e $6-S'Syndro#e $6-S'
De7nition
3he respiratory distresssecondary to #econiu#aspiration &y the fetus in uteroor &y the neonate during la&orand delivery:
1earning Objective 8 Visual +6
![Page 37: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/37.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 37/66
6econiu# -spiration6econiu# -spiration
Syndro#e $6-S' $cont'Syndro#e $6-S' $cont'(athogenesisB aspiration of#econiu# can causeB
• -irway o&struction $&all and valve'
• Severe in;a##ation
• (ul#onary hypertension
• (latelet activation
1earning Objective 8 Visual +*
![Page 38: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/38.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 38/66
Meconium )spiration5yndrome +M)5, +cont,
Risk 9actors o M)5
• 0ost!term pregnancy
• Maternalhypertension
• )bnormal etal heartrate
• :iophysical profle ≤ ;
•
0re!eclampsia• Maternal diabetes
mellitus
• 5()
• Chorioamnionitis
1earning Objective 8 Visual +$
![Page 39: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/39.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 39/66
Meconium )spiration5yndrome +M)5, +cont,
Clinical presentation o M)5
• Meconium staining o amniotic 'uid beorebirth-
• Meconium staining o neonate ater birth-
• Respiratory distress leading to increased
anteroposterior diameter o the chest-• 0ersistent pulmonary hypertension o the
newborn +004",-
1earning Objective 8 Visual +-
![Page 40: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/40.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 40/66
Meconium )spiration5yndrome +M)5, +cont,
#nvestigations or M)5
• 1aboratory studies
– :lood gas analysis
– :lood culture and C:C
1earning Objective 8 Visual 4%
![Page 41: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/41.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 41/66
Meconium )spiration5yndrome +M)5, +cont,
#nvestigations or M)5
• Radiologic studies
– Chest <!ray& fndings include patchyinfltrates= coarse streaking o both
lung felds= hyperin'ation o the lungand 'attening o the diaphragm-
1earning Objective 8 Visual 41
![Page 42: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/42.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 42/66
Visual 42
Meconium )spiration
![Page 43: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/43.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 43/66
Meconium )spiration5yndrome +M)5, +cont,
Management o M)5
0renatal management&• #dentifcation o high!risk pregnancy-
• Monitoring o etal heart rate duringlabor-
• )mnioinusion +>,
1earning Objective 8 Visual 4+
Meconium )spiration
![Page 44: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/44.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 44/66
Meconium )spiration5yndrome +M)5, cont,
Management o M)5
%elivery room management& +iamniotic 'uid is
meconium stained,• Obstetrical& 5uction o the oropharynx by
obstetrician beore delivery o shoulders-
• 0ediatric& ?isualiation o vocal cords andtracheal suction i inant is not breathing-
1earning Objective 8 Visual 44
i i i
![Page 45: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/45.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 45/66
Meconium )spiration5yndrome +M)5, +cont,
• (eneral Management o "eonate withM)5
– @mpty the stomach contents to avoidurther aspiration-
– Correction o metabolic abnormalities e-g-hypoxia= acidosis= hypoglycemia=
hypocalcemia and hypothermia-
– 5urveillance or end organ hypoxicAischemicdamage +brain= kidney= heart and liver,-
1earning Objective 8 Visual 4,
M i ) i i
![Page 46: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/46.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 46/66
Meconium )spiration5yndrome +M)5, +cont,
• Respiratory Management o "eonatewith M)5
– 9re*uent suction and chest vibration-
– 0ulmonary toilet to remove residualmeconium i intubated-
– )ntibiotic coverage +ampicillin andgentamicin,-
– $se C0)0-
1earning Objective 8 Visual 46
![Page 47: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/47.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 47/66
![Page 48: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/48.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 48/66
)ir 1eak 5yndromes%efnition
The air leaks syndromes+pneumomediastinum= pneumothorax=pulmonary interstitial emphysema andpneumopericardium, comprise a spectrumo diseases with the same underlyingpathophysiology- Overdistension oalveolar sacs or terminal airways leads to
disruption o airway integrity= resulting indissection o air into surrounding spaces-
1earning Objective ; Visual 4$
![Page 49: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/49.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 49/66
)ir 1eak 5yndromes +cont,
#ncidence
Most commonly seen in neonates withlung disease who are on ventilatorysupport but can also occurspontaneously- The more severe the
lung disease= the higher the incidenceo pulmonary air leak-
1earning Objective ; Visual 4-
![Page 50: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/50.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 50/66
![Page 51: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/51.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 51/66
![Page 52: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/52.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 52/66
Visual ,2
)ir 1eak 5yndromes +cont,
![Page 53: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/53.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 53/66
)ir 1eak 5yndromes +cont,
Clinical 0resentation o "eonates with)ir 1eak
5yndromes
• Respiratory distress or sudden deteriorationo clinical course with alteration o vital
signs and worsening o blood gases-• )symmetry o thorax is present in unilateral
cases-
1earning Objective ; Visual ,+
![Page 54: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/54.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 54/66
)ir 1eak 5yndromes +cont,
#nvestigations or )ir 1eak5yndromes
• The defnitive diagnosis o all air leaksyndromes is made radiographically by
an )!0 chest <!ray flm and a lateralflm-
1earning Objective ; Visual ,4
![Page 55: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/55.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 55/66
![Page 56: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/56.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 56/66
)ir 1eak 5yndromes +cont,
Management o )ir 1eak 5yndromes
• (eneral – )void ventilators
– Careul use o manual bag ventilation• 5pecifc
–
%ecompression o air leak according tothe type-
– %o not needle the chest
1earning Objective ; Visual ,6
![Page 57: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/57.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 57/66
![Page 58: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/58.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 58/66
)pnea +cont,
Risk 9actors o "eonatal )pnea
• (athological apnea
– 4ypothermia
– 4ypoglycemia
– )nemia
– 4ypovolemia
– )spiration – "@C A %istension
1earning Objective E Visual ,$
Cardiac disease .ung disease
Gastro intestinal re/lu0
Airway obstruction
n/ection 'eningitis
Neurological disorders
![Page 59: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/59.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 59/66
)pnea +cont,
#nvestigations• Monitoring at!risk neonates less than 6D
weeks gestational age-
• @valuate or a possible underlying cause-
• 1aboratory studies should include a C:C=blood gas analysis= serum glucose=electrolyte= and calcium levels-
• Radiologic studies i chest disease issuspected
1earning Objective E Visual ,-
![Page 60: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/60.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 60/66
)pnea +cont,
Management o )pnea• (eneral Therapy
– 0erorm tactile stimulation-
–
C0)0 in recurrent and prolongedapnea-
– 0harmacological therapy +ca/eine ortheophylline, may be re*uired-
• Monitor levels-
1earning Objective E Visual 6%
![Page 61: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/61.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 61/66
)pnea +cont,
Management o )pnea
• 5pecifc Therapy
– Treatment o the cause= i identifed= eg-treatment o sepsis= hypoglycemia=anemia= and electrolyte abnormalities-
1earning Objective E Visual 61
![Page 62: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/62.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 62/66
)pnea +cont,
Outcome and 0rognosis
• #n most neonates apnea resolveswithout the occurrence o long!termdefciencies-
1earning Objective E Visual 62
![Page 63: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/63.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 63/66
5ummary& 1earning
Objectives2- @valuate the severity o respiratorydistress using the %ownFs 5core-
D- #dentiy common neonatal
respiratory disorders= including& – Transient Tachypnea o the "ewborn +TT",
– Respiratory %istress 5yndrome +R%5,
– Meconium )spiration 5yndrome +M)5,
–
)ir leak syndromes – )pnea
– 0neumonia
1earning Objectives Visual 6+
![Page 64: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/64.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 64/66
![Page 65: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/65.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 65/66
5ummary& 1earning
Objectives +cont,8- #dentiy the risk actors= clinical
presentation= re*uired laboratory
and radiological investigations=management o M)5-
;- #dentiy the incidence= risk actors=
clinical presentations= re*uiredradiological investigations= andmanagement o air leak syndromes-
1earning Objectives Visual 6,
![Page 66: IT 28 - Respiratory Distress - JUL](https://reader031.vdocuments.us/reader031/viewer/2022021120/55cf903e550346703ba43974/html5/thumbnails/66.jpg)
7/21/2019 IT 28 - Respiratory Distress - JUL
http://slidepdf.com/reader/full/it-28-respiratory-distress-jul 66/66
5ummary& 1earning
Objectives +cont,E- #dentiy the incidence= risk
actors= causes= re*uired
investigations= and managemento apnea-
G- #dentiy the etiology= clinical
presentation= re*uiredinvestigations= and managemento pneumonia-