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8/13/2019 RESPIRATORY DISORDERS (Abdurahman S).ppt
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RESPIRATORY DISORDERS
Dr. Abdurahman Sukadi, dr., SpAK
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MANAGEMENT
Temperature : 36,50
C
37,50
COksigenFluid TherapyMinimal HandlingPositionChest Radiograph
AntibioticsBlood pressure monitoring
Arterial Blood gas Analysis and pH
Laboratorium : Blood Count and differential Culture
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MECONIUM ASPIRATION
Definition :Aspiration of mecoinum-stained amniotic
fluid by the fetus in utero or by the newborn
during labor and delivery
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PATHOPHYSIOLOGYPhysiologic meconium passage
(particulary if postdates)
Fetal compromised (hypoxia, cord
compression, etc.)
meconium passage
Meconium stainned amniotic fluid
Post partumaspiration
In uterogasping
Meconium aspiration
Continued
compromise
Peripheralairway
obstruction
Proximalairway
obstruction
Inflammatoryand chemicalpneumonitis Remodeling of
pulmonaryvasculature
Complete
Atelectasis
V/Q mismatch
Partial
Ball valve effect
Air - trapping
Air - leaks
AcidosisHypoxemiaHypercapnia
Persistentpulmonaryhypertension
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THERAPYDelivery Room Management
Meconium in amniotic fluid
Meconium in amniotic fluid
Thin Thick
Infantactive
Infantdepressed
Suctiontrachea
Observe
Resuscitate PRN Resuscitate PRN
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GENERAL MANAGEMENT
Temperature
Metabolic
Cardiopulmonary FunctionFluid
Antibiotics
OKSIGEN PaO2 : 50 80 mmHg.
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TRANSIENT TACHYPNEA OF
THE NEWBORN (TTN)
DEFINITION : Also known as wet lung and type II respiratory
distress syndrome. It is a benign disease of near
term, term or large prematur infants who haverespiratory distress shortly after delivery thatusually resolves within 3 days.
PATHOPHYSIOLOGY
Delayed resorption of fetal lung fluid Pulmonary immaturity
Mild surfactan deficiensy
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DIAGNOSIS
CLINICAL PRESENTATION :
Term infant
Family with risk factor Tachypnea ( > 60 x/min)
LABORATORIUM :
Hypoxemia Mild respiratory acidosis
Improvement within 24 hours
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RADIOLOGIC : Hyperaeration, mild cardiomegaly
Sunburst
Resolves within 2 3 days
THERAPY
Oksigen
Fluid restriction
Resolves within 48 72 hours
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A P N E A
DEFINITION :
Absence of respiratory, with or without
bradycardia or cyanosis
CLASSIFICATION :
Central Apnea
Obstructive Apnea Mixed Apnea
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ETIOLOGY, based on :
Disease
Gestational age Post natal age
PATHOPHYSIOLOGY
Immaturity of respiratory control Sleep realted response
Protective reflexes
Muscle weakness
All of the above point to an immaturerespiratory control mechanism in thepretern infant
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THERAPY
Preventive
Aminophyllin
Continuous positive airway presure
(CPAP)
Mechanical ventilation
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HYALINE MEMBRANE DISEASE
(RESPIRATORY DISTRESS
SYNDROME)
DEFINITION :
Respiratory distress syndrome in a preterm
newborn with respiratory difficulty,including tachypnea, chest retraction and
cyanosis, that persists or progresses over
the first 48 96 hours of life and with a
characteristic chest x
ray film (uniformreticulogranular pattern and air
bronchograms)
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PATHOPHYSIOLOGYPrematurity
Surfactant synthesis and release
Alveolar surface tension
Atelectasis
Hypoxemia, Hypercarbia
Acidosis (respiratory and metabolic)
Pulmonary vascular resistance andvasoconstriction
Pulmonary capillary leak
Hyaline membranes ( diffusion block)
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DIAGNOSIS
Preterm infant, respiratory difficulty
Chest x ray : Uniform reticulogranular
Pattern and Air BrochogramsLaboratorium :
Blood count : No Infection
Blood culture : Negative
Arterial Blood gas : Hipoxemia and Acidemia
L/S Ratio : < 2 : 1
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THERAPY :
Temperature
Oksigen
Fluid and Electrolyte
Circulation
Antibiotics