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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.

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Case Study Presentation

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  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.

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