You are called to transport a 36 week baby who appears to have a form of cyanotic heart lesion. When you arrive at the referring hospital the child is quite cyanotic.
Vitals are as follows: HR 186, RR 88, BP 62/38 in upper extremity and 40/26 in lower extremity. Pulses are very weak in all extremities. I
nitial blood gas is 7.31/46/31 HCO3 19 BE -5.
Capillary refill is +5 and the baby is mottled.
The skin temperature is cold and clammy.
A. What type of heart lesion do you think this is?
B. What are other types of cyanotic heart lesions?
C. What are the first steps? Is this baby stable?
D. What are the pharmacological treatments? What fluids and what rate would you use?
You are 2 hours from your facility. What might you need to do before you transport this baby.?
( hint: remember the side effects of one of the drugs this baby should be receiving )
E. What types of complications can happen?
A. Before you leave, what information in important to have?
B. Would you like any diagnostic tests before you leave e.g. labs, abg, x-rays?
The follow up abg is as follows: 7.29/49/32 HCO3 19 BE -5;
What do you do? What do you say to the parents?
H. Explain the steps of intubation and give the hazards.
A. What types of IV lines would be desirable?
B. What would you live your FIO2 to be during transport?
C. Justify your answer for the last question.
After intubation of this baby, what are appropriate ventilator settings? How did you decide on these settings?
Discuss the side effects of higher FIO2's on cyanotic heart disease. If you needed less than 21%
FIO2, what would indicate this.
Explain the difference between Nitric Oxide ( NO ) and nitrogen ( N2 ).
These two gasses differ greatly, what disease processes are associated with each.
Does the transport team have the capacity to perform ventilation with these gasses?
Are you ready to leave the referring facility? Is there anything else needed?
If you are satisfied with your work, you may call report, see if the attending physician would like anything else, then you successfully return back to your hospital.
Aku nk try gak jwb bnda ni.... nnti pikir jap!!
Respond la kengkawan!!
mana dapat soalan nih? Puas otak aku pk.
1.coartation of aorta
2. first stabilize the patient first, this patient is hemodynamically not stable..
1. stabilize the vital sign by giving pharmacological and non phamarcological treatment
2. pharmacological treatmert 4 option of drugs
a. diuretic - frusemide
b.ace inhibitor -captopril
c. inotropic agent .
d. beta-blocker
3. give 100% oxygen
....
x habis jawab lagi nie
tlog check dulu .
lps tu i give my next answer
faiz nor
Memang ada ciri coarctation of aorta, tp COA bukan cyanotic heart lesion.
Generally, cyanotic heart disease is a problem of the right chamber of the heart.
A. What type of heart lesion?
Hypoplastic of the left heart
B. What other types?
Pulmonary valve stenosis
Tetralogy of fallot
Tricuspid atresia
Hypoplastic of the left heart
C. First steps..
ABC must be secured first. The baby should be oxygenated. (maybe intubate??) The baby is obviously not stable. He is tachypnoeic, tachycardic, and he appeared to be in shock. The ABG shows hypoxia
D. Pharmacolgy? And fluid?
Then, if it is a Hypoplastic of the left heart, prostaglandin should be given to ensure the PDA is patent
Fluid susah nak jwb la. X reti sgt.
kalo left hypoplastic heart syndrome,there's nothing much dat we can do..
jawapanye..hypoplastic of the left heart!!!
so,have to give prostaglandin for this baby.
frusemide to reduce the systemic & lung congestion.