Just Breathe
What are the 3 most common respiratory distress in a newborn infant?
Transient Tachypnea of the Newborn (TTN)
Respiratory Distress Syndrome (RDS)
Meconium Aspiration Syndrome (MAS)
A 29 year old man living in Utah comes to the ED 90 minutes after he received a snake bite to his right leg. He was cleaning in a shed in his backyard when he saw a snake between two beams of wood. He doesn't really remember what it looked like other than it was brown (he had a few beers while cleaning his shed). His temp is 99.1F, pulse 105/min, RR 26/min, BP 96/52 mmHg. On exam, he shows two erythematous puncture wounds with serous drainage just above the right ankle. There is ecchymosis and swelling across the dorsum of the right foot and the lower leg up to the mid-shin. Active and passive range of motion of the right knee and ankle is limited to pain. Neuro exam shows no abnormalities. What is the most appropriate next step in management?
Administration of antivenom
Six hours after birth, a newborn boy is evaluated for tachypnea. he was delivered at 41 weeks gestation via C-section and the amniotic fluid was meconium stained. His RR is 75/min. Physical exam showed elevated pulmonary artery pressure. He is started on inhaled medication that increases smooth muscle cGMP, and there is immediate improvement in his tachypnea and oxygenation status. Three hours later, the newborn is tachypneic and there is blue-grey discoloration of the lips, fingers and toes. Which of the following is the most likely cause of the infant's cyanosis?
A. Increase in concentration of serum myoglobin
B. Closure of the ductus arteriosus
C. Oxidization of Fe2+ to Fe3+
D. Inhibition of mitochondrial cytochrome c oxidase
E. Allosteric alteration of heme groups
C. Oxidation of Fe 2+ to Fe 3+
Inhaled nitritic oxide (NO) is the mainstay tx for PPHN because of its ability to potentially vasodilate the pulmonary vasculature without decreasing systemic vascular resistance. A side effect of inhaled NO is the oxidation of ferrous iron (Fe2+) to ferric iron (Fe3+) at high levels, resulting in the formation of methemoglobin. Because Fe3+ has a reduced affinity for oxygen binding, methemoglobin is a poor oxgen transporter.
What is more dangerous a grown Northern Pacific Rattlesnake or a baby Copperhead in terms of snake bites?
Baby Copperhead.
A 36 year old woman, G3P2, at 42 weeks gestation comes to the doctor for induction of labor. Her pregnancy is uncomplicated. Her 2 other children are born via vaginal deliveries at full term. Her only medication in a prenatal multivitamin. She is 5ft 5in and weights 200 lbs, BMI 33 kg/m2. Her temperature is 36.8C, pulse 90/min, RR 14/min, and BP 110/80 mm Hg. Exam shows a nontender, soft uterus consistent with size of a 42 week gestation. The patient's child is at greatest risk of which of the following complications?
A. Polyhydramnios
B. Neonatal respiratory distress syndrome
C. Caudal regression syndrome
D. Meconium Aspiration
E. Placental abruption
Meconium Aspiration
A 47 year old woman comes to the ED because of worsening pain, discoloration and swelling of her right hand. Two days ago she was camping outdoors in Texas with her 2 children and was woken up in the middle of the night by something crawling on her hand. She saw a wound the following morning that was initially painless, but over the next several hours she noticed reddening and blistering. Yesterday, the lesion turned blue with a blackish discoloration at the center. Her temperature is 100.4F and pulse 83/min, BP 128/84, PE shows a bluish plaque with a central area of necrosis surrounded by a rim of erythema at the dorsum of the right hand. What is mostly responsible for the patient's symptoms?
A. Bald-faced hornet
B. Diamondback rattlesnake
C. Brown recluse spider
D. Striped bark scorpion
E. Deer tick
F. Black widow spider
C. Brown recluse spider - endemic to southern, southeastern and midwestern US.
You are working on the L&D floor and walk in to a room to help with a newborn delivery. When you look at the chart, the mother did not receive any prenatal care before delivery. Based on ultrasound findings, it is assumed she is ~38 weeks gestation. When the baby comes out he is not breathing. You quickly suction the mouth and nose and give oxygen via bag-mask ventilation. Very quickly the neonate becomes cyanotic. When listening to lung sounds, they are normal on the right and absent on the left side. Heart sounds are best heard in the right midclavicular line. The abdomen appears concave. What is the most appropriate initial step in the management of this patient?
Intubation and mechanical ventilation