test 3 peds

• Neural tube defects

  Incomplete closure of vertebrae and neural tubes
• Types of neural tube defects

  • Spinal bifida occult
  • Meningocele
  • Myelomeningocele
• Spinal bifida occult

  Midline defect involving failure of osseous spine to close, not visible
• Meningocele

  External sac-like protrusions filled with cerebrospinal fluid, no nerve findings
• Myelomeningocele

  Visible defect with external sac-like protrusion which encases meninges, spinal fluid and nerve endings sticking out
• Vital signs in neural tube defects

  • Cushing triad: wide pulse pressure, bradycardia, irregular respiratory rate
• Management of increased intracranial pressure (ICP)

  1. Reduces volume- shunts

  2. Preserves cerebral metabolic function: O2, Perfusion, ICP/CPP monitoring

  3. Avoids situations which increase ICP
• Meningitis

  Infection process of CNS inflammation, exudation, WBC accumulation, varying degree of tissue damage
• Diagnostic for meningitis

  CSF culture
• Management of meningitis

  IV antibiotics promptly, draw lab first
• Other CNS infections


  • Encephalitis
  • Reye's syndrome
  • Guillian Barre
• Encephalitis

  Inflammation of the brain due to viral illness
• Reye's syndrome

  Encephalopathy by viral infection followed by fatty hepatic changes, metabolic and neurological failure, increase use of ASA
• Guillian Barre

  Progressive ascending motor weakness associated with infection
• Cytokine cascade

  1. Rapid bacterial lysis- release bacterial fragments- increase inflammation and ICP

  2. Dexamethasone prior to antibiotics-inhibits cytokine cascade
• Epidural hematomas

  Arterial rapid pooling of blood
• Subdural hematomas

  Venous origin- slow pooling of blood
• Atrial septuml defect

  Opening between the atria
• Atrial septal defect

  • Left to right shunt, murmur, heart failure
• Treatment of atrial septal defect

  Conservative- may close on own, surgical patch if moderate to large, transcatheter
• Ventricular septal defect

  Opening between the ventricles
• Ventricular septal defect

  • Murmur, heart failure
• Treatment of ventricular septal defect

  Small may close on own, palliative- pulmonary bounding to limit amount of blood shunt, larger surgically graft patch and pulmonary bond removed
• Atrioventricular canal defect

  ASD and VSD
• Atrioventricular canal defect

  • Murmur, heart failure
• Treatment of atrioventricular canal defect

  Surgical repair patch of septal defect and repair valve
• Patent ductus arteriosus

  Failure of the ductus to close
• Patent ductus arteriosus

  • Murmur, bounding pulses, widening pulse pressure
• Treatment of patent ductus arteriosus

  Medical indomethacin, surgical- ligation clip or coil insertion
• Coarctation of the aorta

  Narrowing of the aorta segment pre or post ductal
• Coarctation of the aorta

  • Increase pressure in head/upper extremities, decrease lower extremities, weak or absent femoral pulses, heart failure, severe rapid deterioration acidosis and hypotension
• Treatment of coarctation of the aorta

  Nonsurgical balloon angioplasty, stent, thoracotomy resection- end to end anastomosis
• Aortic stenosis

  Narrowing of the aortic valve
• Aortic stenosis

  • Can have sudden MI or low cardiac output with sudden death, left heart failure risk
• Pulmonary stenosis

  Narrowing entrance to pulmonary artery
• Pulmonary stenosis

  • Right ventricle hypertrophy, right heart failure, cardiomegaly, risk of endocarditis
• Treatment of pulmonary stenosis

  Balloon angioplasty, surgical valvotomy- replace valve mechanical (lasts longer but risk of obstruction) or biological
• Tetralogy of Fallot

  4 defects- VSD, pulmonary stenosis, RV hypertrophy, overriding aorta
• Tetralogy of FallotClinical

  • Cyanosis, murmur, tetrad spells
• Treatment of tetralogy of Fallot

  Palliative modified BT shunt, complete repair closure of VSD and opening pulmonary valve