X

Download Black and White-Pediatrics House Staff PowerPoint Presentation

SlidesFinder-Advertising-Design.jpg

Login   OR  Register
X


Iframe embed code :



Presentation url :

Home / General & Others / General & Others Presentations / Black and White-Pediatrics House Staff PowerPoint Presentation

Black and White-Pediatrics House Staff PowerPoint Presentation

Ppt Presentation Embed Code   Zoom Ppt Presentation

PowerPoint is the world's most popular presentation software which can let you create professional Black and White-Pediatrics House Staff powerpoint presentation easily and in no time. This helps you give your presentation on Black and White-Pediatrics House Staff in a conference, a school lecture, a business proposal, in a webinar and business and professional representations.

The uploader spent his/her valuable time to create this Black and White-Pediatrics House Staff powerpoint presentation slides, to share his/her useful content with the world. This ppt presentation uploaded by worldwideweb in General & Others ppt presentation category is available for free download,and can be used according to your industries like finance, marketing, education, health and many more.

About This Presentation

Slide 1 - Apparent Life-Threatening Events (ALTE) in Infants Ashna Khurana, MD Santa Clara Valley Medical Center
Slide 2 - Goals and Objectives Review the Differential Diagnosis for ALTE Discuss the most common Etiologies of ALTE Discuss the yield of Diagnostic Testing in infants who have had an ALTE Identify infants with ALTE that need to be Hospitalized.
Slide 3 - Case Study 3 week old FT female infant presents to the SCVMC ED after experiencing an episode at home where mother found the infant: Gagging, one hour after feeding Turned limp Unresponsive for about 45 seconds Cried spontaneously Mother thinks the infant stopped breathing at the time and thought her baby was going to die.
Slide 4 - Case Study (cont'd) In the ED: Stable vitals Well appearing Normal physical exam ED physician pages the pediatric resident for consult and wants to know what to do with the infant.
Slide 5 - Definition of ALTE NIH Consensus Development Conference on Infantile Apnea and Home Monitoring 1986 An episode that is frightening to the observer and is characterized by some combination: Apnea Color change Marked changes in muscle tone Choking Gagging
Slide 6 - Definition of ALTE (cont'd) In some instances, the caregiver has feared that the infant was going to die. Previous misleading terms such as “near-miss SIDS” or “aborted crib deaths” Not a diagnosis
Slide 7 - Incidence of ALTE True frequency and prevalence are unknown. Estimated to be 0.05 to 1% in population-based studies. Other studies have shown an estimate of up to 6% of all infants or 0.6 to 9.4 in 1000 of live-born infants. Account for 0.6% to 0.8% of all emergency department visits for children under 1 year of age.
Slide 8 - ALTE vs. SIDS No clear association or link ALTE < 2 months of age No maternal age difference Usually occurs between 8am and 8pm No change in incidence with Back to Sleep campaign SIDS Peak age 2-4 months Mothers more likely to be under age 20 years Usually occurs between midnight and 6am Decreased incidence with Back to Sleep campaign Low-birth weight and SGA ALTE < 2 months of age No maternal age difference Usually occurs between 8am and 8pm No change in incidence with Back to Sleep campaign Esani et al. Journal of Pediatrics March 2008
Slide 9 - Why is an infant with an ALTE episode so worrisome to the medical provider?
Slide 10 - Differential Diagnosis GI Gastroesophageal reflux Intussusception, Volvulus, Swallowing incoordination, Incarcerated hernia Neurologic Seizures, breath holding spells, Vasovagal syncope, CNS hemorrhage, hydrocephalus, Neuromuscular disorders ID RSV/bronchiolitis, Pertussis, UTI, Sepsis, Meningitis, Encephalitis, Pneumonia
Slide 11 - Differential Diagnosis (cont’d) Respiratory Upper airway obstruction, foreign body aspiration, Immaturity or prematurity, Central hypoventilation syndrome, Vocal cord dysfunction, Laryngotracheomalacia, vascular ring Cardiac Disease Arrhythmia (long QT syndrome, WPW), congenital heart disease, cardiomyopathy, myocarditis Metabolic disorders IEM, Hypoglycemia, Hypocalcemia, Hypomagnesemia
Slide 12 - Differential Diagnosis (cont’d) Child Abuse Accidental or intentional poisoning, Non-accidental suffocation, Physical injury, Head injury, Factious illness (MBP) Other Developmental delay, Feeding difficulties, Medications, Hypothermia, Anemia, Food Allergy, Anaphylaxis Normal Behaviors of Infants Irregular breathing of REM sleep, periodic breathing, respiratory pauses, transient choke, gag, cough during feeding Idiopathic/Unknown etiology
Slide 13 - Most common discharge diagnosis for ALTE: Idiopathic/Unknown (50% of all ALTE cases) Gastroesophageal Reflux Seizure Lower respiratory tract infection
Slide 14 - Evaluation HISTORY is the most important diagnostic tool Detailed description of the event including: position of infant at the time events leading up to the episode interventions taken prior to presentation was infant awake or asleep Infant's usual behavior with regards to sleep and feeding habits Pregnancy and Birth History Developmental History
Slide 15 - History (cont'd) Family history: siblings with early deaths, rare conditions, or SIDS Social history: smokers, substance abuse, medications in the home Administration of medications prior to event, including OTC meds and homeopathic medications
Slide 16 - Evaluation (cont'd) Physical Examination is the second most important diagnostic tool Obtain Vital Signs, including Pulse Oximetry Plot out height, weight, and head circumference Complete head to toe exam with particular attention to the respiratory, cardiac and neurologic exam Consider fundoscopic exam
Slide 17 - ALTE and GER Most common diagnosis for an ALTE episode Direct cause of the respiratory event is likely laryngospasm (resulting response is apnea, bradycardia, swallowing and/or hypertension). More likely due to reflux when: Gross emesis occurs at time of ALTE Episodes occur when infant is awake and supine The ALTE is characterized by obstructive apnea Reflux is pathologic when the infant has esophagitis, bleeding, FTT, or pulmonary aspiration. Mousa et al. Testing the association between GER and apnea in infants. Journal of Pediatric Gastroenterology and Nutrition 2005; 41: 169-177
Slide 18 - ALTE and SEIZURES Second most common cause of ALTE Studies have determined seizures to be etiology of ALTE in up to 15-25% of all diagnosable cases. Of those that developed chronic epilepsy, 71% returned within 1 month with second ALTE. Significant predictors of adverse neurologic outcomes are family history of seizures and male gender Neurological evaluation with first time ALTE is low yield. Bonkowsky et al. Death, Child Abuse, and Adverse Neurological Outcome of Infants After an Apparent Life-Threatening Event. Pediatrics 2008; 122: 125-131.
Slide 19 - ALTE and Infectious Diseases Third most common cause of ALTE Pertussis RSV/Bronchiolitis - cause for apnea in High Risk Infants: full term but less than 1 month of age preterm but less than 48 weeks PCA infants with h/o apnea prior to evaluation. any infant with bronchiolitiis may develop apnea as result of respiratory distress, respiratory muscle fatigue or hypoxia. Shah S. Sharieff G, An update on the approach to apparent life-threatening events. Current Opinion in Pediatrics 2007; 19: 288-294.
Slide 20 - ALTE and Child Abuse Few studies done to determine incidence of infants with ALTE that were found to be victims of abuse Some studies have detected up to 2-3% Historical clues Occurs only in presence of single caretaker Presents with apnea or cyanosis Infant required CPR Even though recurrent, a myriad of diagnostic testing is all negative Siblings may have history of SIDS
Slide 21 - The physical exam is normal in up to 85% of infants after an ALTE. NOW WHAT?
Slide 22 - Brand et al. Pediatrics 2005 Looked at yield of diagnostic testing in infants who have had an ALTE 243 infants who were admitted to large Children's Hospital outside of New York over 32 month period Of 3776 tests ordered, 669 (18%) were positive but only 224 (6%) contributed to the diagnosis Brand et al. Yield of Diagnostic Testing in Infants Who Have Had an Apparent Life-Threatening Event. Pediatrics 2005; 115: 885-893.
Slide 23 - Brand et al. Pediatrics 2005 (cont'd) Useful tests in patients who had a CONTRIBUTORY History and Physical: CBC, Chemistry Panel, UA and cultures CSF analysis and culture Metabolic screening Screening for respiratory pathogens Screening for GER CXR Brain neuroimaging Skeletal survey EEG Echo pneumogram
Slide 24 - Brand et al. Pediatrics 2005 (cont'd) Useful tests in patients who had a NON-CONTRIBUTORY History and Physical: screening for GER CXR UA and culture Pneumogram brain neuroimaging WBC Concluded that broad evaluations for systemic infections, metabolic diseases, and blood chemistry abnormalities are not productive in the group of infants who have a non-contributory history and physical
Slide 25 - Diagnostic Studies (cont'd) Highest diagnostic yield: Rapid glucose determination CBC Urinanalysis and culture RSV and Pertussis test EKG CXR Consider – dilated fundoscopic exam, brain neuroimaging, urine toxicology screen, lactate, EEG, testing for pathologic reflux
Slide 26 - Who should be admitted?
Slide 27 - Admission Criteria Most studies recommend ALL infants with ALTE should be admitted for observation and further evaluation over 24-72 hour period, regardless of the cause of the ALTE and the appearance of the infant at presentation. Few studies have specifically evaluated admission vs. discharge home criteria
Slide 28 - Admission Criteria (cont’d) No consensus guidelines for admission Most hospitalizations are done on an individual patient need basis Further benefits to hospitalization: Alleviating parental fears and anxiety CPR training Possibility of health care provider to witness an episode
Slide 29 - Return back to Case Study 3 week FT female infant presents to the SCVMC ED after experiencing an episode at home where mother found the infant: Gagging one hour after feeding Turned limp Unresponsive for about 45 seconds Cried spontaneously In the ED: Stable vitals Well appearing Normal physical exam
Slide 30 - Case Study (cont'd) What do you tell the ED physician?
Slide 31 - Case Study (cont'd) Given that the infant has a history significant for ALTE episode consider: CBC, CRP, Chem 10, UA/U.cx, EKG, CXR But remember – “Monitoring only” may be appropriate if event was promptly reversible; short-lived, self-limited; baby is stable on initial monitor, and all observed feeds are reassuring Given infant's age, as well as mother's fear that her baby was going to die, would admit for a minimum of 24 hour period of observation on CR monitor.
Slide 32 - Take Home Points Most common etiologies include GER, Seizures, and Lower Respiratory Tract Infection Always consider Child Abuse History is the most important diagnostic tool Most infants should be admitted for period of observation at minimum, but there may be a small subset that can be discharged.
 

Frequently Asked Questions

> About SlidesFinder?

Slidesfinder is a website that allows users to upload and share their PowerPoint presentations online. It provides a platform for individuals and businesses to share their ideas and knowledge through presentations, and for others to view and download these presentations for educational or professional purposes.
Slidesfinder offers a wide range of presentation topics and categories, including business, education, science, technology, health, and more. Users can also search for presentations using keywords, tags, or by category. The website provides tools to create professional presentations with rich media, animations, and graphics.



One of the key features of Slidesfinder is its user-friendly interface, which allows users to easily upload, view, and share presentations. Users can also embed their presentations in their websites or blogs using the website's embed code feature.
Slidesfinder also offers premium services, such as the ability to create private presentations and to download presentations in high-quality formats. However, the basic features of Slidesfinder are free to use, making it accessible to anyone who wants to share their ideas and knowledge through presentations.

> How do I register with SlidesFinder?

Go to registration page (you can see signup link on top of website page) https://www.slidesfinder.com/signup . If you have facebook/gmail account them just click on SIGN IN WITH FACEBOOK OR SIGN IN WITH GOOGLE button, by this you will be a registered member of slidesfinder without filling any form, required detail automatically will be fatch from your account. If you do not a Facebook account, then click on "Signup". Fill all required fields and you will be a registered member of slidesfinder.

> Is slidesfinder account confirmation is mandatory?

Yes it is mandetory to active your account to login.

> Do I need to signup/login on SlidesFinder before uploading a PowerPoint presentation?

Yes, you need to login with your account before uploading presentation. Your username will be displayed on your uploaded presentation. Your registered email id is needed for sending your stats of uploaded presentation.

Slidesfinder is a sharing website for PowerPoint presentations search and share. Find your interest in the form of powerpoint presentations on slidesfinder and save your valuable time . On Slidesfinder you get presentations from our huge library of professional ppt presentations. We believe in making your search INFORMATIVE and FUN. Find your best ppt presentation from a pool of PowerPoint presentations stacked under important industry categories like business & management, heath & Wellness,eduction & training etc. We provide unique informative PowerPoint presentation for marketers, presenters and educationists. These professional PowerPoint presentations are uploaded by professionals from across numerous industry segments.These ppt presentations are available for FREE download.

Not just finding your interest, but facilitate you broadcast your interest. We have created this platform for easy sharing of PowerPoint presentations, ensuring that these presentations get maximum exposure. Create your slidesfinder account and upload PowerPoint presentations for free, share on social media platforms and BUILD YOUR CROWD WITH PRESENTATION !!

The Great Buddha says, "Share your knowledge.It’s a way to achieve immortality"! So, start sharing knowledge and we are here to make that immortal !!

© 2013-2022 SlidesFinder. All rights reserved.

Re-productivity of content are not allowed. Without prior written permission from author, commercial use of any content is illegal.