Special Situations Flashcard

C. Rationale: A diffusely hazy pattern in the entire left lung field suggests a large pleural effusion. This is caused by the extravasation of fluid in the left thoracic cavity. The pressure exerted by the fluid restricts the movement of the lung, causing respiratory distress. A thoracentesis is recommended in this case to relieve the pressure build-up that is hindering the respiratory effort.

D. Rationale: Thoracentesis is a procedure that involves placing a 19 or 20 gauge catheter into the pleural space to relieve it from unwanted air or fluid. The procedure is reserved for cases of large pleural effusion and pneumothoraces. If the volume of fluid or air is small, monitoring the patient is indicated because pleural effusions and pneumothoraces can resolve spontaneously.

D. Rationale: The management includes respiratory support with oxygen and mechanical ventilation. In severe cases, the patient may need inhaled nitric oxide, which is a potent vasodilator, or the use of extracorporeal membrane oxygenation.

B. Rationale: Preterm newborns have low lung compliance and stiff lungs; consequently they are prone to pneumothorax, especially after providing positive pressure ventilation. Meconium aspiration can cause major obstructions in the airways that necessitate an increase in peak inspiratory pressure when providing PPV, which is a major risk factor for barotrauma and leads to pneumothorax. When a newborn is being given mechanical ventilation and suddenly deteriorates, the most common cause is pneumothorax.

C. Rationale: Thoracentesis is an emergency procedure wherein a cannula is inserted through the thoracic cavity to evacuate accumulated fluid or air and relieve pressure buildup within the area.

B. Rationale: After the above interventions, the team must continue performing chest compressions and ventilation. It may be necessary to call for expert help at this time. An advanced airway may be placed if not already done. A STAT chest X-ray may provide valuable information, such as the presence of a pneumothorax. The team should reassess the interventions by asking the following: Is the chest moving with each breath? Are equal breath sounds present? Is the advanced airway obstructed? Are we giving 100% oxygen through the PPV device? Are the chest compressions being done correctly? Have we given the correct dosage of epinephrine? Is there a pneumothorax?

B. Rationale: It is recommended to use a gauge 18 or gauge 20 catheter-over-needle when performing emergency thoracentesis in the newborn infant.

D. Rationale: Auscultation for breath sounds is an important examination to confirm the presence of pneumothorax. However, due to the small thoracic cavity, the resonance of breath sounds can be distorted or misleading, causing a false-negative detection of pneumothorax. Diminished breath sounds are expected on the side of the pneumothorax. Other causes of diminished breath sounds include inadequate ventilation technique, wrong endotracheal tube positioning, pleural effusion, tracheal obstruction, congenital diaphragmatic hernia, pulmonary hypoplasia, cardiomegaly, and mechanical ventilation equipment failure (such as air leakage).