sick neonates by trish woods for smacc mini
TRANSCRIPT
SICK NEONATES ARE SIMPLE
SICK NEONATES ARE SIMPLE
SICK NEONATES ARE SIMPLE
A Nightmare
RUN AWAY!!
Get inside the mind of a newborn
Sweet IN-UTERO LIFE
Big Outside World
What Could Possibly
Go Wrong ?
What Could Possibly
Go Wrong ?
LOTS…
JUST BREATHE…
JUST BREATHE…
PEEP OR NO PEEP ?
JUST BREATHE…
PEEP OR NO PEEP ?
No PEEP
Phase contrast x-ray imaging of the lung
S.J.HOOPER et al SPring-8/SACLA 2012;17(3):232-237
No PEEP
Phase contrast x-ray imaging of the lung
S.J.HOOPER et al SPring-8/SACLA 2012;17(3):232-237
With PEEP
With PEEP
Don’t Be PEEP SHY
Going to intubate
Going to intubate
Going to intubate
Does Depth Matter?
PULMONARY FLOW
Ventilated
Lung
Non-
Ventilated
Lung
Increase in pulmonary blood flow at birth: role of oxygen
and lung aeration J.A.LANG et al J Physiol. 2016 594(5):1389-1398
Lang,JL
PULMONARY FLOW
Ventilated
Lung
Non-
Ventilated
Lung
Increase in pulmonary blood flow at birth: role of oxygen
and lung aeration J.A.LANG et al J Physiol. 2016 594(5):1389-1398
Lang,JL
Clamp the cord ?
Clamp the cord ?
early or delayed?
PULMONARY Blood FLOW Rise
Cardiovascular transition at birth: a physiological sequence
S.B.HOOPER et al Pediatric Research 2015;77(5): 608 - 614
failure To Transition
Switch the balance
SICK CARDIAC FUNCTION
SICK CARDIAC FUNCTION
SICK Filling & Pulmonary
resistance SICK CARDIAC Filling
SICK Filling & Pulmonary
resistance SICK CARDIAC Filling
SICK CARDIAC Output
Ductus Arteriosus Flow
Ductus Arteriosus Flow
TURN THE PDA WORM
TURN THE PDA WORM
lung Recruitment
lung Recruitment
lung Consolidation
lung Consolidation
Mirror image..
Screen the lungs for Air Leak
Ribs
pleural
line
More
Ribs ??!
Mirror image..
Screen the lungs for Air Leak
Ribs
pleural
line
More
Ribs ??!
Lack
Pleural
sliding
A Line
profile
Absent B Lines
sliding coarse
pleural
line
Coalescent
B Lines
LUNG POINT
Lack
Pleural
sliding
A Line
profile
Absent B Lines
sliding coarse
pleural
line
Coalescent
B Lines
LUNG POINT
Liver
huge amount
of Pleural fluid
squished lung
Pleural EFFUSIONS
Liver
huge amount
of Pleural fluid
squished lung
Pleural EFFUSIONS
The Essentials
The Adventure Begins…