Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
Pediatric Airway Anatomy Physiology and Management.ppt
1. Basics of Pediatric Airway
Anatomy, Physiology and
Management
Christine Mai, MD
Claudine Mansour, MD
Faculty Advisor: Ruth Padilla, MD
Boston University Medical Center
Department of Anesthesiology
Share ur PPTs on Telegram channel: Anaesthesia PPTs
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2. The Pediatric Airway
• Introduction
• Normal Anatomy
• Physiology
• Airway evaluation
• Management of
normal vs. abnormal
airway
• Difficult airway
3. Introduction
• Almost all of pediatric codes are due to respiratory origin
• 80% of pediatric cardiopulmonary arrest are primarily due
to respiratory distress
• Majority of cardiopulmonary arrest occur at <1 year old
• 1990 Closed Claim Project by ASA
• Respiratory events are the largest class of injury (34%)
• More common in children than adults
• 92% of claims occurred between 1975-1985 before continuous
pulsoximetry and capnography (Brain damage and death in 85%
of cases)
• With continuous O2 sat and ETCO2 monitoring after 1990s,
decrease in brain damage and death (56% 1970s to 31% 1990s)
4. Normal Pediatric Airway Anatomy
• Larynx composed of hyoid
bone and a series of
cartilages
• Single: thyroid, cricoid,
epiglottis
• Paired: arytenoids,
corniculates, and cuneiform
5. Pediatric Anatomy cont.
Laryngeal folds consist of:
• Paired aryepiglottic folds extend from epiglottis posteriorly to
superior surface of arytenoids
• Paired vestibular folds (false vocal cords) extend from thyroid
cartilage posteriorly to superior surface of arytenoids
• Paired vocal folds (true vocal cords) extend from posterior surface
of thyroid plate to anterior part of arytenoids
• Interarytenoid fold bridging the arytenoid cartilages
• Thyrohyoid fold extend from hyoid bone to thyroid cartilage
Sensory Innervation:
Recurrent Laryngeal Nerve-supraglottic larynx
Internal Branch of Superior Laryngeal Nerve-infraglottic larynx
Motor Innervation:
External branch of Superior Laryngeal Nerve-cricothyroid muscle
Recurrent Laryngeal Nerve-all other laryngeal muscles
Blood Supply
Laryngeal branches of the superior and inferior thyroid arteries
6. 5 Differences between Pediatric and Adult
Airway
• More rostral larynx
• Relatively larger tongue
• Angled vocal cords
• Differently shaped epiglottis
• Funneled shaped larynx-narrowest part of
pediatric airway is cricoid cartilage
7. More rostral pediatric larynx
Laryngeal apparatus develops from brachial clefts and descends caudally
Infant’s larynx is higher in neck (C2-3) compared to adult’s (C4-5)
8. Relatively larger tongue
• Obstructs airway
• Obligate nasal breathers
• Difficult to visualize larynx
• Straight laryngoscope blade
completely elevates the epiglottis,
preferred for pediatric
laryngoscopy
Angled vocal cords
• Infant’s vocal cords have more
angled attachment to trachea,
whereas adult vocal cords are
more perpendicular
• Difficulty in nasal intubations
where “blindly” placed ETT may
easily lodge in anterior
commissure rather than in trachea
Image from: http://www.utmb.edu/otoref/Grnds/Pedi-airway-2001-01/Pedi-
airway-2001-01-slides.pdf
9. Differently shaped epiglottis
• Adult epiglottis broader, axis parallel to trachea
• Infant epiglottis ohmega (Ώ) shaped and angled away
from axis of trachea
• More difficult to lift an infant’s epiglottis with
laryngoscope blade
10. Funneled shape larynx
• narrowest part of infant’s
larynx is the undeveloped
cricoid cartilage, whereas in
the adult it is the glottis
opening (vocal cord)
• Tight fitting ETT may cause
edema and trouble upon
extubation
• Uncuffed ETT preferred for
patients < 8 years old
• Fully developed cricoid
cartilage occurs at 10-12
years of age
Image from: http://www.hadassah.org.il/NR/rdonlyres/59B531BD-
EECC-4FOE-9E81-
14B9B29D139B1945/AirwayManagement.ppt
INFANT
ADULT
11. Pediatric Respiratory Physiology
• Extrauterine life not possible until 24-25 weeks of gestation
• Two types of pulmonary epithelial cells: Type I and Type II
pneumocytes
• Type I pneumocytes are flat and form tight junctions that
interconnect the interstitium
• Type II pneumocytes are more numerous, resistant to oxygen
toxicity, and are capable of cell division to produce Type I
pneumocytes
• Pulmonary surfactant produced by Type II pneumocytes
at 24 wks GA
• Sufficient pulmonary surfactant present after 35 wks GA
• Premature infants prone to respiratory distress syndrome
(RDS) because of insufficient surfactant
• Betamethasone can be given to pregnant mothers at 24-35wks GA to
accelerate fetal surfactant production
12. Pediatric Respiratory Physiology cont.
• Work of breathing for each kilogram of body weight is
similar in infants and adult
• Oxygen consumption of infant (6 ml/kg/min) is twice that
of an adult (3 ml/kg/min)
• Greater oxygen consumption = increased respiratory rate
• Tidal volume is relatively fixed due to anatomic structure
• Minute alveolar ventilation is more dependent on
increased respiratory rate than on tidal volume
• Lack Type I muscle fibers, fatigue more easily
• FRC of an awake infant is similar to an adult when
normalized to body weight
• Ratio of alveolar minute ventilation to FRC is doubled,
under circumstances of hypoxia, apnea or under
anesthesia, the infant’s FRC is diminished and
desaturation occurs more precipitously
13. Physiology: Effect Of Edema
Poiseuille’s law
R = 8nl/ πr4
If radius is halved, resistance increases 16 x
Image from: http://www.hadassah.org.il/NR/rdonlyres/59B531BD-EECC-4FOE-9E81-14B9B29D139B1945/AirwayManagement.ppt
14. Normal Inspiration and Expiration
turbulence
Image from: http://www.hadassah.org.il/NR/rdonlyres/59B531BD-EECC-4FOE-9E81-14B9B29D139B1945/AirwayManagement.ppt
16. • URI predisposes to coughing,
laryngospasm, bronchospasm,
desat during anesthesia
• Snoring or noisy breathing
(adenoidal hypertrophy, upper
airway obstruction, OSA)
• Chronic cough (subglottic
stenosis, previous
tracheoesohageal fistula
repair)
• Productive cough (bronchitis,
pneumonia)
• Sudden onset of new cough
(foreign body aspiration)
• Inspiratory stridor
(macroglossia, laryngeal web,
laryngomalacia, extrathoracic
foreign body)
• Hoarse voice (laryngitis, vocal
cord palsy, papillomatosis)
• Asthma and bronchodilator
therapy (bronchospasm)
• Repeated pneumonias (GERD,
CF, bronchiectasis,
tracheoesophageal fistula,
immune suppression, congenital
heart disease)
• History of foreign body aspiration
• Previous anesthetic problems
(difficulty intubation/extubation
or difficulty with mask
ventilation)
• Atopy, allergy (increased airway
reactivity)
• History of congenital syndrome
(Pierre Robin Sequence, Treacher
Collins, Klippel-Feil, Down’s
Syndrome, Choanal atresia)
• Environmental: smokers
Airway Evaluation
Medical History
17. Signs of Impending Respiratory Failure
• Increase work of breathing
• Tachypnea/tachycardia
• Nasal flaring
• Drooling
• Grunting
• Wheezing
• Stridor
• Head bobbing
• Use of accessory muscles/retraction of muscles
• Cyanosis despite O2
• Irregular breathing/apnea
• Altered consciousness/agitation
• Inability to lie down
• Diaphoresis
18. Airway Evaluation
Physical Exam
• Facial expression
• Nasal flaring
• Mouth breathing
• Drooling
• Color of mucous membranes
• Retraction of suprasternal,
intercostal or subcostal
• Respiratory rate
• Voice change
• Mouth opening
• Size of mouth
• Mallampati
• Loose/missing teeth
• Size and configuration of palate
• Size and configuration of
mandible
• Location of larynx
• Presence of stridor
(inspiratory/expiratory)
• Baseline O2 saturation
• Global appearance (congenital
anomalies)
• Body habitus
19. Diagnostic Testing
• Laboratory and radiographic evaluation extremely helpful
with pathologic airway
• AP and lateral films and fluoroscopy may show site and
cause of upper airway obstruction
• MRI/CT more reliable for evaluating neck masses,
congenital anomalies of the lower airway and vascular
system
• Perform radiograph exam only when there is no
immediate threat to the child’s safety and in the presence
of skilled personnel with appropriate equipment to
manage the airway
• Intubation must not be postponed to obtain radiographic
diagnosis when the patient is severely compromised.
• Blood gases are helpful in assessing the degree of
physiologic compromise; however, performing an arterial
puncture on a stressed child may aggravate the underlying
airway obstruction
20. Airway Management: Normal Airway
• Challenging because of unique anatomy
and physiology
• Goals: protect the airway, adequately
ventilate, and adequately oxygenate
• Failure to perform any ONE of these tasks
will result in respiratory failure
• Positioning is key!
21. Bag-Mask Ventilation
•Clear, plastic mask with inflatable rim
provides atraumatic seal
•Proper area for mask application-bridge
of nose extend to chin
•Maintain airway pressures <20 cm H2O
•Place fingers on mandible to avoid
compressing pharyngeal space
•Hand on ventilating bag at all times to
monitor effectiveness of spontaneous breaths
•Continous postitive pressure when needed
to maintain airway patency
Image from: http://www.hadassah.org.il/NR/rdonlyres/59B531BD-EECC-4FOE-9E81-14B9B29D139B1945/AirwayManagement.ppt
24. Nasopharyngeal Airway
•Distance from nares to angle of mandible approximates the proper length
•Nasopharyngeal airway available in 12F to 36F sizes
•Shortened endotracheal tube may be used in infants or small children
•Avoid placement in cases of hypertrophied adenoids - bleeding and
trauma Image from: http://www.hadassah.org.il/NR/rdonlyres/59B531BD-EECC-4FOE-9E81-14B9B29D139B1945/AirwayManagement.ppt
26. Selection of laryngoscope blade:
Miller vs. Macintosh
• Miller blade is preferred for infants and younger
children
• Facilitates lifting of the epiglottis and exposing
the glottic opening
• Care must be taken to avoid using the blade as a
fulcrum with pressure on the teeth and gums
• Macintosh blades are generally used in older
children
• Blade size dependent on body mass of the patient
and the preference of the anesthesiologist
27. Endotracheal Tube
New AHA Formulas:
Uncuffed ETT: (age in years/4) + 4
Cuffed ETT: (age in years/4) +3
ETT depth (lip): ETT size x 3
Age Wt ETT(mm ID) Length(cm)
Preterm 1 kg 2.5 6
1-2.5 kg 3.0 7-9
Neonate-6mo 3.0-3.5 10
6 mo-1 3.5-4.0 11
1-2 yrs 4.0-5.0 12
28. Complications of Endotracheal Intubation
• Postintubation Croup
• Incidence 0.1-1%
• Risk factors: large ETT, change in patient position introp,
patient position other than supine, multiple attempts at
intubation, traumatic intubation, pts ages 1-4, surgery >1hr,
coughing on ETT, URI, h/o croup
• Tx: humidified mist, nebulized racemic epinephrine, steroid
• Laryngotracheal (Subglottic) Stenosis
• Occurs in 90% of prolonged endotracheal intubation
• Lower incidence in preterm infants and neonates due to relative
immaturity of cricoid cartilage
• Pathogenesis: ischemic injury secondary to lateral wall pressure
from ETT edema, necrosis, and ulceration of mucosa, infx
• Granulation tissues form within 48hrs leads to scarring and
stenosis
29. Cuff vs Uncuffed Endotracheal Tube
• Controversial issue
• Traditionally, uncuffed ETT recommended in children < 8 yrs old to
avoid post-extubation stridor and subglottic stenosis
• Arguments against cuffed ETT: smaller size increases airway
resistance, increase work of breathing, poorly designed for pediatric
pts, need to keep cuff pressure < 25 cm H2O
• Arguments against uncuffed ETT: more tube changes for long-term
intubation, leak of anesthetic agent into environment, require more
fresh gas flow > 2L/min, higher risk for aspiration
-Concluding Recommendations-
• For “short” cases when ETT size >4.0, choice of cuff vs uncuffed
probably does not matter
• Cuffed ETT preferable in cases of: high risk of aspiration (ie. Bowel
obstruction), low lung compliance (ie. ARDS, pneumoperitoneum,
CO2 insufflation of the thorax, CABG), precise control of ventilation
and pCO2 (ie. increased intracranial pressure, single ventricle
physiology)
Golden, S. “Cuffed vs. Uncuffed Endotracheal tubes in children: A review” Society for Pediatric Anesthesia. Winter 2005 edition.
30. Laryngeal Mask Airway
• Supraglottic airway device developed by Dr. Archie Brain
• Flexible bronchoscopy, radiotherapy, radiologic procedures, urologic,
orthopedic, ENT and ophthalmologic cases are most common
pediatric indications for LMA
• Useful in difficult airway situations, and as a conduit of drug
administration (ie. Surfactant)
• Different types of LMAs: Classic LMA, Flexible LMA, ProSeal
LMA, Intubating LMA
• Disadvantages: Laryngospasm, aspiration
LMA size Weight Max cuff volume (mL) ETT (mID)
1 .0 Neonate/Infants ≤ 5kg 4 3.5
1.5 Infants 5-10kg 7 4.0
2.0 Infants/children 10-20kg 10 4.5
2.5 Children 20-30kg 14 5.0
3.0 Children/small adult > 30kg 20 6.0 cuff
4.0 Normal/large adolescent/adult 30 7.0 cuff
5.0 Large adolescent/adult 40 8.0 cuff
31. Other Supraglottic Devices
• Laryngeal tube
• Latex-free, single-lumen silicone tube, which is closed at distal end
• Two high volume-low pressure cuffs, a large proximal oropharyngeal cuff
and a smaller distal esophageal cuff
• Both cuffs inflated simultaneously via a single port
• Situated along length of oropharynx with distal tip in esophagus
• Sizes 0-5, neonates to large adults (only sizes 3-5 available in US)
• Limited data available for its use in children
• Cobra Perilaryngeal Airway
• Perilaryngeal airway device with distal end shaped like a cobra-head
• Positioned into aryepiglottic folds and directly seats on entrance to glottis
• Inflation of the cuff occludes the nasopharynx pushing the tongue and soft
tissues forward and preventing air leak
• Available in sizes pediatric to adult ½ to 6
• No studies currently available evaluating this device in children
35. Congenital Anomalies
Tracheoesphageal Fistula
• Feeding difficulties (coughing, choking and
cyanosis) and breathing problems
• Associated with congenital heart (VSA, PDA,
TOF), VATER, GI, musculoskeletal and urinary
tract defects
• Occurs in 1/ 3000-5000 births
• Most common type is the blind esophageal pouch
with a fistula between the trachea and the distal
esophagus (87%)
Clark, D. “Esophageal atresia and tracheoesophageal fistula” American Family Physician. Feb 15,
1999. Vol 59(4) http://www.aafp.org/afp/99021ap/910.htlm
Radiograph of a neonate with
suspected esophageal atresia.
Note the nasogastric tube coiled
in the proximal esophageal pouch
(solid arrow). The prominent
gastric bubble indicates a
concurrent tracheoesphageal
fistula (open arrow)
36. Congenital Anomalies
Choanal Atresia
• Complete nasal obstruction of
the newborn
• Occurs in 0.82/10 000 births
• During inspiration, tongue
pulled to palate, obstructs oral
airway
• Unilateral nare (right>left)
• Bilateral choanal atresia is
airway emergency
• Death by asphyxia
• Associated with other
congenital defects
Tewfik, T. “Choanal atresia” emedicine.com
http://www.emedicine.com/ent/topic330.htm
37. Congenital Syndromes
Pierre Robin Sequence
• Occurs in 1/8500 births
• Autosomal recessive
• Mandibular hypoplasia,
micrognathia, cleft palate,
retraction of inferior dental arch,
glossptosis
• Severe respiratory and feeding
difficulties
• Associated with OSA, otitis
media, hearing loss, speech
defect, ocular anomalies, cardiac
defects, musculoskeletal
(syndactyly, club feet), CNS
delay, GU defects)
Tewfik, T. “Pierre Robin Syndrome” emedicine.com
http://www.emedicine.com/ent/topic150.htm
38. Congenital Syndrome
Treacher Collins Syndrome
• Mandibulofacial dysotosis
• Occurs in 1/10 000 births
• Cheek bone and jaw bone
underdeveloped
• External ear anamolies, drooping
lower eyelid, unilateral absent
thumb
• Respiratory difficulties
• Underdeveloped jaw causes
tongue to be positioned further
back in throat (smaller airway)
• Associated with OSA, hearing
loss, dry eyes
www.ccakids.com/syndrome/treacher.pdf
39. Congenital Syndrome
Down’s Syndrome
• Trisomy 21
• Occurs in 1/660 births
• Short neck, microcephaly,
small mouth with large
protruding tongue, irregular
dentition, flattened nose, and
mental retardation
• Associated with growth
retardation, congenital heart
disease, subglottic stenosis,
tracheoesophageal fistula,
duodenal atresia, chronic
pulmonary infection, seizures,
and acute lymphocytic
leukemia
• Atlantooccipital dislocation
can occur during intubation
due to congenital laxity of
ligaments
http://www.nlm.nih.gov/medlineplus/ency/article/0000997.htm
40. Inflammatory
• Etiology: Haemophilus influenzae
type B
• Occurs in children ages 2-6 years
• Disease of adults due to
widespread H. influenza vaccine
• Progresses rapidly from a sore
throat to dysphagia and complete
airway obstruction (within hours)
• Signs of obstruction: stridor,
drooling, hoarseness, tachypnea,
chest retraction, preference for
upright position
• OR intubation/ENT present for
emergency surgical airway
• Do NOT perform laryngoscopy
before induction of anesthesia to
avoid laryngospasm
• Inhalational induction in sitting
position to maintain spontaneous
respiratory drive
(Sevo/Halothane)
• Range of ETT one-half to one size
smaller
41. Inflammatory
• Etiology: Parainfluenza virus
• Occurs in children ages 3 months
to 3 years
• Barking cough
• Progresses slowly, rarely requires
intubation
• Medically managed with oxygen
and mist therapy, racemic
epinephrine neb and IV
dexamethasone (0.25-0.5mg/kg)
• Indications for intubation:
progressive intercostal retraction,
obvious respiratory fatigue, and
central cyanosis