physiologic development.pptx

8/18/2019 PHYSIOLOGIC DEVELOPMENT.pptx

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PHYSIOLOGICDEVELOPMENT

NEONATAL & PEDIATRICRESPIRATORY CARE

OLFU – College of Respiratory Therapy

D ! ADUL" #D


2/59

TRANSITION PERIOD: Pulmonary

Circulation

• Fetal $l% flo to the l'(g) *+,

– *+*- the a.o'(t fo'(% i(

e/tra'teri(e life

• Fetal l'(g) (ot a( orga( for

gas e/0ha(ge

• !loo% is sh'(te% aay fr The

l'(g thr' the %'0t's arterios's

• Rt 1e(tri0'lar o'tp't goes

fro. PA to aorta

• Di.i(ishe% a.o'(t of $l% that

ret'r(s fro. P1 to LA also

2oi(s the $loo% i( the aorta


3/59

• O3 $l% pla0e(ta

'.$ili0al 4ei( %'0t's

4e(os's RA FO

LA L1 aorta

• I(0 resista(0e to $l% flo

i( arterial $e% of l'(g

• Resista(0e .ay $e i(0

$y hypo/ia

• Re%'0e% $y i(0 -3 &

%e0 C-3 or 56 0o(0( I(

p'l. Art !l%


4/59


5/59

At $irth7• L'(gs are i(flate% + air

• #e0ha(i0al e/pa(sio( %e0 p'l.o(ary 4as0'lar

resista(0e %'e to 0ha(ges i( -3" C-3 a(% p5

• !l% flo i(0 i( l'(gs .ore $l% ret'r(e% to LA i(0

LA press're fora.e( o4ale 0loses

• Fetal $l% flo) R to L at $irth" $l% flo L to R DA

0loses

• FO & DA 0loses soo( after $irth $'t .ay reope( i( %ays

after $irth

• FO) respo(si4e to press're 0ha(ges $et 3 atria

• DA) respo(%s to p-3 & prostagla(%i( le4els – #ay $e .a(ip'late% $y 'si(g i(%o.etha0i( to 0lose or

P8E3 to ope( it


6/59

FETAL LNG FLID

• Fetal l'(g is fille% + fl'i% 9:-.l+;g!


7/59

Deter.i(atio( of l'(g %e4elop.e(t

• Too little a.(ioti0 fl'i% %'e to a.(ioti0 fl'i%

lea;i(g or %e0 'ri(e pro%'0tio(

'(%er%e4elope%+hypoplasti0 l'(g• Oligohy%ra.(ios – Potter?s sy(%ro.e

• 8ro'p of a(o.alies) oli!o"y#ramnio$ $%&u%nc% – Pulmonary "y'o'la$ia

– F%tal com'r%$$ion ()latt%n%# )a0e & e/tre.ities=

• De0 fetal $reathi(g .o4e.e(ts

'(%er%e4elope% l'(gs• De0 thora0i0 spa0e %iaphrag.ati0 her(ia

– S.all or poorly %e4elope% l'(gs


8/59

• 5or.o(es 0a( ha4e a( effe0t o( groth of l'(g

• Cortisol – pri(0ipal hor.o(e – 96= str'0t're% l'(g %e4elop.e(t & pro%'0tio( of

s'rfa0ta(t

• Fa0tors that sti.'late l'(g .at'ratio( – ACT5" thyroi% hor.o(es" estra%iol" prola0ti("

epi%er.al groth fa0tor" P8

• I(s'li( & testostero(e) 9@= s'rfa0ta(t sy(thesis


9/59

L'(g I(flatio( at !irth

• Fetal respiratory .o4e.e(ts) sig( of fetal ell@

$ei(g – Respiratory .o4e.e(ts (ot 0o(ti('o's" o00'r i(

$'rsts of a0ti4ity

– #ay $e %epresse% $y %r'gs or a(esthesia

– I.pt To %e4elop.e(t of l'(gs & resp .'s0les of

fet's

• :- .i(s after $irth) aerate% l'(gs 9ter.= – FRC) ,B i(itial respiratory 4ol'.e – [email protected]

– I(itial resi%'al 4ol'.e) 3-@:-.l

– Preter.s) i(0 effort to i(flate l'(gs" te(%s to %eflate


10/59

• *st ; of life) – I(0 i( 0o.plia(0e fro. 3.l+0.53- to @.l+0.53-

9relate% to s'rfa0e te(sio(=

• Sti.'l's for N! to $reathe) fa0tors – C'ta(eo's sti.'li

– #a2or sti.'l's) %e0 -3" i(0 C-3

• CS %eli4ery) N! has (o effort to $reathe for *st

se0o(%s – E/erts .ore effort o( i(itial e/pa(sio( of l'(gs

– #ay ha4e so.e sig(s of respiratory %istress

• #ay hear rales o( a's0'ltatio( $'t 0leare% i( fe

.i(s


11/59

S'..ary

• Fetal l'(g fl'i% at $irth rapi%ly .o4e% o't of .a2or

airays & repla0e% $y air %'ri(g *st fe $reaths at

$irth re>'iri(g .ore for0e tha( s'$se>'e(t

$reaths

• I(itiatio( of *st $reath is spo(ta(eo's & res'lt of

%e0 -3" i(0 C-3 i( i(fa(t?s $loo% & 0'ta(eo's

sti.'latio( asso0iate% + $irth pro0ess


12/59

LUN8 8RO


13/59

• Rapi% al4eolar .'ltipli0atio() *st 3 yrs of life

• Appro/i.ate H of a%'lt al4eoli rea0he% at G y+o

• Tr'e al4eoli prese(t at $irth 9= –

Parts of N!?s l'(g e/0ha(ge gas & a0t li;e al4eoli• Reti0'lar && elasti0 fi$ers i( N! l'(g LO<

– L'(g str'0t're is ea; i( N!

• RR i( N!) -@-+.i(

• ,y+o) 3-@:-+.i(


14/59

SRFACE FORCES

• S'rfa0e te(sio( %epe(%s o( ha4i(g air@li>'i%

i(terfa0e

• Fl'i% i(itially prese(t i( airay affe0ts the a$ility of

l'(g to $e i(flate%

• A.(ioti0 fl'i% has .ore resista(0e to .o4e.e(t

tha( l'(g li>'i%

• L'(g li>'i% + s'rfa0ta(t has the loest

resista(0e• Little or (o s'rfa0ta(t) i(0 te(%e(0y for l'(g

0ollapse – S'rfa0ta(t %i.i(ishes s'rfa0e for0es & %e0 the

te(%e(0y of l'(g to 0ollapse


15/59

I.porta(0e of s'rfa0ta(t

• Sta$iliJes the l'(g & allo a( air 4ol'.e ;(o(

as FRC to $e prese(t at e/piratio(

• Pro4i%es for a .ore 0o.plia(t l'(g – Easier to i(flate

• Keep e/0ess fl'i% o't of the air spa0es i( the l'(g

• I(0 i( s'rfa0ta(t 'p to : ;s AO8 ff% $y sharp

i(0 at :, ;s

•

Pre.at're i(fa(t – Di.i(ishe% s'rfa0ta(t

– No/io's sti.'li 9asphy/ia" a0i%osis= at $irth RDS

– 8l'0o0orti0oi%s to .other $efore $irth 96= s'rfa0ta(t

pro%'0tio( to %e0 ris; of RDS a.o(g PT


16/59

S'..ary7

• S'rfa0ta(t) sy(thesiJe% $y type II al4eolar 0ells – For.s a s'rfa0e fil. that allo l'(gs to retai(

resi%'al air" i(0 0o.plia(0e" helps re.o4e al4eolar

fl'i%

• Appears *st at 3;s AO8


17/59

#EC5ANICS OF 1ENTILATION• I(spiratio(

– Diaphrag. 0o(tra0ts

– A$%o.i(al 0o(te(t %es0e(% & .o4e forar%

– I(0 0hest 0a4ity

– E(large.e(t of ri$ 0age 9.i(i.al=

• I(fa(ts+0hil%re() 0hest appears to si(; i( %'ri(g

i(spiratio(

– ParalyJe% he.i%iaphrag.) 9esp %'ri(g $irth=

• ParalyJe% si%e ill .o4e i( opposite %ire0tio( or

'par% %'ri(g i(spiratio( – A00essory .'s0les of i(spiratio( 'se% he( i(0

$reathi(g is (ee%e%

• E/t i(ter0ostal .'s0les) life ri$s for 0hest e/pa(sio(


18/59

– Stre('o's $reathi(g)

• A00essory .'s0les lift ster('. & ele4ate *st 3 ri$s

• Alar flari(g

• E/piratio( – passi4e – + rela/atio( after i(spiratio( l'(g & 0hest all

ret'r(s to resti(g positio( air lea4es 0hest

– A0ti4e phase of e/piratio(

• I(t i(ter0ostal .'s0les %e0 0hest %ia.eter"

%iaphrag. p'she% 'par% – Ne$or() e/piratio( i(terr'pte% $efore rela/atio(

4ol'.e" prote0ti(g FRC


19/59

Press're@4ol'.e relatio(ships

• 5ysteresis – Differe(0e $et I(spiratio( & e/piratio(

• Resti(g positio() there is still so.e gas i( l'(g

•


20/59

Co.plia(0e• Ease at hi0h it is %efor.e% or %iste(%e%

•1ol'.e 0ha(ge per '(it of press're

• A%'lt l'(g has greater 0o.plia(0e tha( i(fa(t l'(g

• Spe0ifi0 0o.plia(0e) 0o.pari(g 0o.plia(0e +

spe0ifi0 '(it of l'(g 4ol'.e 9FRC=

• Re%'0e% he() – P'l.o(ary 4essels e(gorge% + $loo%

– Stiff l'(g %'e to i(fla..atory pro0ess

– P'l.o(ary e%e.a

– Atele0tasis @ parts of l'(g ha4e 0ollapse%

• Ol%er 0hil%) 0o.plia(0e is fre>'e(0y %epe(%e(t – De0reasi(g + i(0 fre>'e(0y


21/59

Co.plia(0e

• Classi0 .etho% for .eas'ri(g l'(g 0o.plia(0e

has $ee( to .eas're Tra(sp'l.o(ary press're

that %iste(%s the l'(g $y 0o.pari(g i(traple'ral

press're + airay press're & %eter.i(e

0o(se>'e(t 4ol'.e 0ha(ge

• #etho%s i( .eas'ri(g stati0 l'(g 0o.plia(0e – I(terr'pt flo at 4ario's le4els of e/piratio( &

.eas'ri(g press're at e>'ili$ratio(

– I(fa(ts) 'se a(esthesia" positi4e press're &rela/atio( + .'s0le paralyJi(g age(ts

– UtiliJe 5eri(g@!re'er Refle/


22/59

• 1ol'.e .eas're.e(t – Use P(e'.ota0hograph) .eas're flo & 4ol'.e

• Pro$le.s) (asal pro(gs or .as; i(terfere +

$reathi(g patter( – Use of esophageal $alloo( (ot a%4isa$le a.o(g

pre.at'res

– Respiratory i(%'0ta(0e plethys.ograph

• N! 0o.plia(0e –

@ .l+0.53-" FRC *.l+;g


23/59

Pn%umotac"o!ra'" Pl%ty$mo!ra'"


24/59

Resista(0e

• l'(g e/pa(sio( oppose% $y for0es fro. elasti0ity

of l'(g & resista(0e to the .o4e.e(t of air

• Elasti0 for0es that te(% to 0ollapse l'(g is prese(t

hether there is .o4e.e(t or (ot at a(y stage of

e/pa(sio(

• Airay resista(0e is prese(t o(ly he( there is

.o4e.e(t of air – Less ith la.i(ar flo" i(0 + t'r$'le(t flo

– Depe(%s pri.arily o( %ia.eter of air passages

– #a2or resista(0e to air flo i( the l'(g) large air

passages


25/59

• Ne$or(s) (ose $reather – Partial o$str'0tio( of (ose .ay sig(ifi0a(tly i(0 or;

of $reathi(g

– Co.plete o$str'0tio( .ay $e lethal

• Resista(0e %e0 ith i(0 l'(g & airay siJe – I(0 + lo l'(g 4ol'.es

– If l'(g 4ol'.e is e/0ee%i(gly lo" s.all airays at

$otto. of l'(g ill 0ollapse atele0tasis of

%epe(%e(t areas of l'(g – Co(tra0tio( of $ro(0hial s.ooth .'s0le ill also

(arro airays" i(0 airay resista(0e


26/59

TI#E CONSTANTS

• A .eas're of ho fast the l'(g or i(%i4i%'al l'(g

'(it ill e.pty or fill

• E/piratory ti.e 0o(sta(t – Co.plia(0e / Resista(0e

• Rapi% 4e(tilatio( – Not e(o'gh ti.e to e.pty the l'(gs i(0 l'(g

4ol'.e & i(a%4erte(t positi4e e(%@e/piratory

press're if .e0ha(i0al 4e(tilator is 'se% i.pro4e

-3 fro. i(0 .ea( airay press're + re%'0e%4e(tilatio(


27/59


28/59

1ENTILATION

• LUN8 1OLU#ES – Ti%al 1ol'.e) 1ol'.e .o4e% + i(spiratio( or

e/piratio( %'ri(g >'iet $reathi(g

• #a/i.'. i(spiratio( i(0 l'(g 4ol'.e to .a/

i(spiratory le4el• #a/ e/piratio( %e0 l'(g 4ol'.e %o( to resi%'al

4ol'.e

– 1ital Capa0ity)4ol'.e $et #a/ i(spiratio( &

.a/i.'. e/piratio( – FRC 9f'(0tio(al resi%'al 0apa0ity ) 1ol'.e re.ai(i(g

at resti(g e/piratio(


29/59

– Ti%al 4ol'.e" .a/i.'. i(spiratio(" .a/i.'.

e/piratio( easily .eas're% + spiro.eter

– FRC" resi%'al 4ol'.e"total l'(g 0apa0ity .eas're%

+ hole $o%y pletys.ograph

• Ea0h i(spiratio( is 0o.pose% of gas that rea0hesal4eoli & gas that o(ly fills the (o(@gas

e/0ha(gea$le part of l'(g

• Total 4e(tilatio( 1o 4e(tilatio( 9a(ato.i0 %ea%

spa0e= 6 1a 9al4eolar 4e(tilatio(=• 1e(tilatio( has %ire0t effe0t o( pC-3


30/59

1ENTILATION@PERFUSION

RELATIONS5IPS 91+M=

• Neither 4e(tilatio( (or perf'sio( is '(ifor.

thro'gho't l'(g

• 1e(tilatio( & perf'sio( $etter i( loer parts of

l'(g – !e0 Of i(0 hy%rostati0 press're

• Lo 1+M ratio is o(e of 0a'ses of hypo/e.ia

• Other 0a'ses of hypo/e.ia –

5ypo4e(tilatio( @ %e0 -3" i(0 C-3 – Diff'sio( pro$le.s – %isease% l'(g

– Sh'(ti(g – greater i( N! %'e to FO or DA that .ay

re.ai( ope(

• RDS" 0ya(oti0 C5D


31/59

DIFFUSION

• #o4e.e(t of -3 fro. al4eol's to $loo%" C-3 fro.

$loo% to al4eol's 9passi4e pro0ess= – P-3 i( at.) *-,..5g 4e(o's p-3) -..5g

• -3 .o4es rapi%ly i(to the $loo%

• I(0 0ar%ia0 o'tp't 9e/er0ise= re%'0e the tra(sit

ti.e of $loo% thro'gh l'(gs

• 5igh altit'%e) i(spire% -3 is less" .'0h s.aller

gra%ie(t pro$le.s i( getti(g e(o'gh -3 i(to

the $loo%

• Diff'sio( of gas %ire0tly proportio(al to area

here %iff'sio( o00'rs & i(4ersely proportio(al to

thi0;(ess of %iff'sio( .e%i'.


32/59


33/59

• C-3 tra(sporte% i( %issol4e% & 0o.$i(e% for. – #ore sol'$le tha( -3

–

#a2ority 0arrie% as 5C-: – Car$o(i0 a(hy%rase i( r$0 fa0ilitates for.atio( of

0ar$o(i0 a0i% $y hy%rati(g C-3 5C-3

– Also tra(sporte% $o'(% to 0ar$a.i(o gro'ps of hg$

.ole0'le

• !ohr Effe0t ) – At tiss'e le4el" he( there is high C-3 & %e0 -3"

high C-3 ai%s i( '(loa%i(g -3

• 5al%a(e Effe0t – De0 P-3 ai%s i( loa%i(g C-3

• I(0 p-3 ai%s i( '(loa%i(g C-3" %e0 pC-3 i(0

loa%i(g 0apa0ity of -3


34/59

Co(trol of $reathi(g

• #ai( 0e(ter for 4e(tilatio() CNS 9.e%'lla & po(s=

• #e%'lla) rhyth.i0 0e(ter for $reathi(g

• Po(s & .e%'lla a0t together to .o%'late s.ooth

tra(sitio( fro. i(spiratio( to e/piratio( – #o%ifie% i( i(4ol'(tary $reathi(g or $reath hol%i(g

• Ne$or() 0hest all is 0o.plia(t – FRC .ai(tai(e% $y $rea;i(g of so.e i(spiratory

.'s0les %'ri(g e/piratio(

• #a(y sig(als 0o.e to CNS 4ia 4ag's (er4e

• Re0eptors) peripheral 0he.ore0eptors" 0e(tral

0he.ore0eptors" l'(g re0eptors


35/59

• Peripheral 0he.ore0eptors) 0aroti% & aorti0 – Respo(% pri.arily to -3

– Caroti% $o%y) 2'(0tio( of 0o..o( 0aroti% artery – Aorti0 $o%y) ar0h of aorta

– Drop i( p-3 i(0 4e(tilatio(

– Pri.ary respo(se triggere% $y a0'te hypo/ia

–

No role i( 0ha(ges that o00'r %'ri(g e/er0ise $'tpro4i%e so.e respo(se to 0ha(ges i( p5 & PC-3

• Ce(tral 0he.ore0eptors) respo(% to 0ha(ges i(

56 & pC-3 lo0ate% i( CNS (ear .e%'lla i( th

4e(tri0el – Shift i( C-3 0o(0e(tratio( 0o(trols 4e(tilatio( $'t 56

at 0ell'lar le4el is per0ei4e%


36/59

• L'(g re0eptors – P'l.o(ary stret0h re0eptors

•

Dis0harge% %'ri(g l'(g %iste(sio(

affere(t

i.p'lses to 4ag's (er4e respo(si$le for 5eri(g@

!re'er refle/ 9sloi(g of respiratory fre>'e(0y

%'e to i(0 of e/piratory ti.e

• Irrita(t re0eptors) 0a'ses $ro(0ho0o(stri0tio( &

hyperp(ea

• Respo(se to 0ha(ges i( C-3 0o(0e(tratio( is

rapi% & large 0o.pare% to 0ha(ges i( -3 & p5 – No respo(se to 0ha(ges i( -3 0o(0e(tratio( '(til

al4eolar p-3 falls ,-..5g

• Chro(i0 l'(g %isease – !l'(te% respo(se to C-3 hypo/i0 respo(se

– Drop i( p5 i(0 4e(tilatio(


37/59

A(te(atal Assess.e(t a(% 5igh@Ris;

Deli4ery

Fetal a(% Ne$or( Assess.e(t

i( the L a(% D


38/59

O-.%cti,%$

At the 0o.pletio( of this le0t're the st'%e(t ill)

• !e a$le to %is0'ss rele4a(t poi(ts 0o(0er(i(g

A(te(atal Assess.e(t

•

!e a$le to ID the L a(% D 0ases hi0h .ayprese(t a high@ris; %eli4ery

• K(o the para.eters o( hi0h to $ase

a(te(atal+peri(atal assess.e(ts


39/59

E4al'atio( of Neo(atal Patie(t

• Respiratory %istress) *st sy.pto. of gro'p of

0o(%itio(s that a00o'(t for (eo(atal .ortality &

.or$i%ity


40/59

Ant%natal A$$%$$m%nt an#

Hi!"/ Ri$0 D%li,%ry

In#ication$ o) a Hi!"/Ri$0 D%li,%ry:

• I(0o.pete(t Cer4i/•

To/i0 ha$its i( Preg(a(0y• 5yperte(sio( a(% Dia$etes #ellit's• Pre0la.psia

• Se4ere Pre0la.psia•

I(fe0tio's Disease• #'ltiple $irth


41/59

In#ication$ o) a Hi!"/Ri$0 D%li,%ry:•Lo(g 0or%" N'0hal 0or%" 0or% ;(ots•Pla0e(ta A$r'ptio(•Pla0e(ta Pre4ia•Disor%ers of a.i(ioti0 fl'i%• A$(or.alities of U.$ili0al 0or%

•Oligohy%ra.i(os" Polyhy%ra.i(os

Ant%natal A$$%$$m%nt an#

Hi!"/ Ri$0 D%li,%ry


42/59


43/59

Ant%natal A$$%$$m%nt

A(te(atal Aro'(% $irth ti.e" 's'ally0o(si%ere% prior to L a(% D

•

Ultraso'(%• A.(io0e(tesis

• Sha;e test

• Fetal !iophysi0al profile

• Preter. Preg(a(0y• Less tha( : ee;s

)


44/59

In#ication$ o) Hi!"/Ri$0

D%li,%ry• #ag(esi'. s'lfate is gi4e( to stop 0o(tra0tio(s

• !loo% gas ith Ph less tha( *, 0a( $e a(

i(%i0atio( of asphy/ia

• Post@ter. La$or

• Preg(a(0y 0o(ti('e% $eyo(% 3 ee;s

• Pre@ter. less tha( :: ee;s ges age

• La0; of pre(atal 0are

N l A #


45/59

N%onatal A$$%$$m%nt an#

R%$u$citation

N%onatal R%$u$citation Con$i#%ration$ 1"il%A$$%$$in! t"% Pati%nt

• #ai(tai( ar.th•

Col% stress i(0reases o/yge( 0o(s'.ptio(• #ai(tai( a( airay• Pla0i(g a s.all roll '(%er the sho'l%ers ill

0orre0t the positio(• S'0tio( the airay• Sti.'latio(• O$tai( 4as0'lar a00ess• Pro4i%e res's0itati4e %r'gs PRN


46/59

A$$%$$in! t"% N%onat%

• 1ital sig(s

• Apgar s0ore• Neo(atal res's0itatio(•


47/59

:- se0

R%$u$citation o) N%2 3orn

:- se0

Appro/i.ate Ti.e

!irth!irth

Clear of #e0o(i'.

!reathi(g or Cryi(g

8oo% #'s0le To(e

Color Pi(;

Ter. gestatio(

Clear of #e0o(i'.

!reathi(g or Cryi(g

8oo% #'s0le To(e

Color Pi(;

Ter. gestatio(

Yes

Pro4i%e ar.th

Positio(

Clear Airay

9as (e0essary=

Dry" sti.'late

Repositio("

8i4e O3

Pro4i%e ar.th

Positio(

Clear Airay

9as (e0essary=

Dry" sti.'late

Repositio("

8i4e O3

NO

Ro'ti(e Care

Pro4i%e ar.th

Clear Airay

Dry

Ro'ti(e Care

Pro4i%e ar.th

Clear Airay

Dry

E4al'ate)

Respiratio(s

5eart rate

Color

E4al'ate)

Respiratio(s

5eart rate

Color

S'pporti4e

Care

S'pporti4e

Care

!reathi(g

5R *--

Pi(;

PP1PP1

Ap(ea or

5R*--

O(goi(g 0areO(goi(g 0are

5R *--

Pi(;

1e(tilati(g


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:- se0

5R -

5R -

PP1

Chest Co.pressio(s A%.i(ister

Epi(ephri(e

Ti.e

5R -

A t ) N t l


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A$$%$$m%nt o) N%onatal

Pati%nt• 1ital sig(s

• S;i(

• #ottli(g

• Irreg'lar areas of %'s;y s;i( alter(ati(g ith pale

s;i(• Capillary refill

R i t F ti


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R%$'iratory Function

A$$%$$m%nt• Ap(ea

• Perio%i0 $reathi(g• 8r'(ti(g• Nasal flari(g• Retra0tio(s

• Sil4er.a( s0ore

• Stri%or • @ray

N l Fl i # S - t l


51/59

Na$al Flarin! an# Su-/$t%rnal

R%traction$

N l Fl i # S - t l


52/59

Na$al Flarin! an# Su-$t%rnal

R%traction$


53/59

Sil4er.a( s0ore


54/59


55/59

A-#om%n

• Diaphra.ati0 her(ia

• O.phalo0ele• 8astros0hisis• U.$li0al 0or%• A si(gle '.$li0al artery

• Co(ge(ital a(o.alies

• Thi( 0or%• Thi0; 0or%@%ia$eti0s


56/59

H%a# an# N%c0 A$$%$$m%nt

• #[email protected] .o'th

• #i0rog([email protected] 2a

• T@E fist'la

•

Pierre ro$i( sy(%ro.e• Choa(al Artesia

• #a0roglossia


57/59

A$$%$$ an In)ant4$ Cry

• Lo'% a(% 4igoro's@ healthy i(fa(t

• 8r'(ti(g 0ry@ RDS

• 5oarse 0ry@lary(geal e%e.a

•

Cat li;e 0ry@ 0hro.os.e a$(or.ality• 5igh@pit0he% 0ry@ (e'rologi0al %efi0it


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P%#iatric A$$%$$m%nt

Pe%i assess.e(t is fo0'se% o( %iffere(t i(%i0atio(s)

• 5istory a(% assess.e(t

• Chief 0o.plai(t

•

#e%i0al history• Fa.ily history

• E(4iro(.e(tal history

El%m%nt$ o) P%#iatric P"y$ical


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El%m%nt$ o) P%#iatric P"y$ical

A$$%$$m%nt• Assess.e(t• In$'%ction

• RR

• Retra0tio(s

• AP %ia.eter • Digital 0l'$$i(g

• Pal'ation

• Ta0tile fre.it's

• Positio( of tra0hea• P%rcu$$ion

• Au$cultation

physiologic development.pptx

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