1 / 19

Case Study Presentation

Case Study Presentation. Michelle Pryce July 13, 2005. Introduction. Biographical Data General Appearance Social/Family History. Prior Medical History. Former premature infant (33 weeks) Cardiac abnormalities Pulmonary Abnormalities Developmental Abnormalities Metabolic Abnormalities.

titus
Download Presentation

Case Study Presentation

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Case Study Presentation Michelle Pryce July 13, 2005

  2. Introduction • Biographical Data • General Appearance • Social/Family History

  3. Prior Medical History • Former premature infant (33 weeks) • Cardiac abnormalities • Pulmonary Abnormalities • Developmental Abnormalities • Metabolic Abnormalities

  4. Ventricular Septal Defect • VSD is the most common cardiac abnormality • Small VSD can close on their own; large ones require surgery • If serious and uncorrected, VSD can increase pulmonary artery pressures and cause a reversal of blood flow.

  5. Cleft lip and palate • 4th most common birth defect • can affects feedings which in turn affect growth and development • At higher risk for aspiration during feeding • More difficulty breathing due to oral cavity malformation • Later can have problems with speech, ear infections, and tooth development

  6. Asthma • Asthma is characterized by airway inflammation, smooth muscle constriction, and accumulation of secretions. • Can result in mucus plugging and/or atelectasis if not properly controlled • Management of symptoms include use of anti-inflammatory and bronchodilator for immediate symptoms

  7. Hospital CourseMay 27, 2005-present • May 27, 2005 to June 15, 2005 • June 16, 2005 to June 24, 2005 • June 25, 2005 to July 12, 2005

  8. Servo 300 vent 3.5 cuffed ETT @ 11cm PRVC, rate 40, Vt 60, peep 7, FiO2 35% Attempting to deliver an adequate tidal volume to correct atelectasis with as little risk of barotrauma as possible Servo 300 vent Weaning: decrease rate by 2 breaths every 12 hours to maintain adequate pH level and EtCo2 levels Extubated June 15 Re-intubated an placed in SIMV (P) mode No changes made Mechanical Ventilation

  9. Mechanical Ventilation • Flow curve decelerating ramp for better gas distribution

  10. Bronchoscopy Performed 06/20 to determine severity of airway softening Determined to be very severe Even with ventilatory support airway caliber only 60% EEG Performed June 7th to determine cause of seizure activity Results—abnormal EEG, but no definitive cause for seizure activity Diagnostic Tests

  11. Diagnostic Tests • Chest X Ray • ETT position • Resolution of atelectasis • Artificial devices

  12. Lab values K—6.6 (3.5-5) Na—136 (139-146) Cl—98 (98-107) Glucose 113(50-80) BUN 5 (4-9) Creatinine 0.2 (0.2-0.4) Calcium 9.2 (9.0-11.0) Anion gap 3 (7-16) Lab values WBC—23,600 RBC—3.82 HBg—11.3 Hct—33.1 Plt ct--388 Bands--34 Segs--48 Labs and Blood Gases

  13. Labs and Blood Gases • FINGER STICK BLOOD GAS RESULTS • pH-7.30 • PO2-71 • Pco2-51 • HCO3-25.1

  14. Surgeries and Special Procedures • Tracheotomy performed June 23 • Insertion of central line June 18

  15. Respiratory Meds Albuterol/Xopenex Ipratropium bromide Fluticasone Racemic epinephrine Other Meds Propranolol (regulate bp) Morphine/ativan/versed/ fentynal-pain, anti-anxiety Methylprednisone-steriod Tegretol-anagelsic Tylenol-pain relief Ciprofloxacin and rocephin –antibiotics Lansoprazole –tx of acid reflux Medications and their actions

  16. EKG • Shows attempted pacing during a run of non sustained V-tach • Hr reached as high as 225 • Also see the 2nd degree heart block

  17. Normal 100d/5.2kg infant values Cardiac Output 1.0-2.0L CVP—0-8 Rt vent press—22/4 PAP—22/9 Wedge—4-12 Left vent press—87/53 SVR/PVR—20-30 Predicted Values for this patient Cardiac Output--normal CVP –normal Rt vent press- incr (65/9) PAP-increased (60/20) Wedge –normal Left vent press-dec (75/10) SVR/PVR both increased Hemo values

  18. How is he now? • As of July 12, he is stable. • He may be able to go home soon on a home ventilator if he has adequate family support • He has consultation orders for corrective surgeries after discharge from GMH

  19. Sources Referenced • Darovic, Gloria. Hemodynamic Monitoring. 3rd edition. • www.heartpoint.com • www.hemosapiens.com/normnpv.html • www.marchofdimes.org • www.plasticsurgery.org • www.rxlist.com • Whitiker, Kent. Comprehensive Perinatal and Pediatric Respiratory Care. 3rd edition.

More Related