Surgical disorders PPT (2/12)

Nose and mouth: choanal atresia definition, ways to treat (2), and how to diagnose?

Choanal (part of nose) atresia (narrowing). Closure of uni or bilateral UA often associated w/ CHARGE, being a problem as babies normally breathe w/ nose. Big problem is w/ resuscitations: cannot ventilate well as air will split into the stomach and blow it up. 2 ways to treat:

1. Nurse can put in a feeding tube to remove air.

2. tongue goes to palate when baby cries, so can put in oral airway to pus down tongue to partially breathe.

Can easily diagnose by putting in tube + it coiling back upwards.

Nose and mouth: macroglossia and mandibular hypoplasia and what disorders can they happen with (2 ea.)?

macroglossia - aka. enlarged tongue! happens w/ Beckwith-wiedemonn and Down syndrome (both growth disorders) babies. creates obstruction and occlude airway.

mandibular hypoplasia (underdevelopment): Pierre robin (small mandible) or treacher collins (abnormal facial bone structure)

Trachea: tracheoesophageal fistula

Esophagus not fully growing to stomach OR has a hole, allowing things to enter the trach. Sometimes don’t know that its present.

Trachea: renal anomalies and ABGs in regards to when to CPAP and when to use VENT

Kidney’s aren’t mature enough to hold onto bicarb. RTs can adjust ventilator to blow off more CO2 to balance pH.

Normals: 7.30 and CO2 ~50.

When to CPAP: >0.4 FiO2 w/ <50 PaO2, <60 CO2, >7.25

When to vent: >0.6 FiO2 w/ <50, >60, <7.25

Esophageal atresia and tracheoesophageal fistula: definition, symptoms, diagnosis and treatment

Underdevelopment where things are not connected to the right place (atresia = inability to pass, fistula = hole)

symptoms: choking, drooling, coughing

diagnosis: CXR, inability to pass an OG tube

Treatment: surgical repair

Congenital diaphragmatic hernia (CDH) definition and differentiating preop and postop treatments:

Hole varying in size that is majority on left side of diaphragm. Causes abdominal content to migrate up to thoracic cavity, taking up SA and reducing development of what is normally in that space. Can manage either when pre or postop:

1. preop: HFJV w/ permissive hypercapnia + IV lines

2. postop: surgery + chest tubes

Surgery is DELAYED until baby is hemodynamically and respiratory stable.

What kind of tube do you intubate w/ for CDH?

CUFFED tubes! Normally babies have uncuffed tubes to minimize pressure against growing trach; however, cuffed tube in this case will be w/ low pressures and will minimize air dilating intestines, as some of PIP/PEEP will go to intestines.

Diaphragmatic eventration

Abnormal intrusion of diaphragm into thoracic space in one or both sides that can be confirmed w/ US or fluoroscopy. Can be asymptomatic.

Chest wall malformations (3 types)

1. Pectus excavatum: small to large + shallow to deep in chest wall.

2. asphyxiating thoracic dystrophy: rare osteochondrodystophy w/ rare autosomal recessive inheritance pattern

3. scoliosis + kyphoscoliosis

Abdomen: GERD

gastroesophageal reflex is the passage of gastric contents into esophagus. If baby pukes, esophagus does not like acidity and can cause infection. Need to make sure gravity is pointing downwards and be careful with positive pressure.

Abdomen: gastroschisis

Intestines herniates to RS of umbilicus, aka outside of baby w/ no membrane cover. DO NOT DO + PRESSURE VENTILATION (neopuff/ambu). Pressure will go to intestines outside of the baby, making it harder for surgeon to put it inside the baby. EVERYTHING MUST BE STERILE.

develops LATER than omphalocele.

Abdomen: Omphalocele (ON TEST)

always @ umbilicus and have abdominal contents covered by a sac. Occurs early during fetal development and associated w/ cardiac defects.

Surgery done if small + stable or has a staged repair of large + unstable.