jSpinal cord injury resulting from iExcessive traction breech delivery

Jspinal cord injury resulting from iexcessive

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j.Spinal cord injury resulting from: i.Excessive traction (breech delivery) ii.Rotation and torsion (vertex delivery) 3.Clavicle is most frequently fractured bone in the newborn. a.Most often an unpredictable and unavoidable complication b.Risk factors include: i.Large size ii.Mid-forceps delivery iii.Shoulder dystocia c.May present with pseudoparalysis to minimize pain d.Examination will show: i.Crepitus ii.Palpable bony irregularity iii.Possible lack of arm movement on affected side 4.Long bone fracture may present as loss of spontaneous arm or leg movement. a.Treatment includes splinting. b.Check for signs of radial nerve injury with a humerus fracture. 5.Intra-abdominal injury is uncommon in newborns. a.Possible injuries include: i.Liver contusion or fracture ii.Spleen rupture iii.Adrenal hemorrhage b.Bleeding either catastrophic or insidious c.Consider in every newborn presenting with: i.Shock or unexplained pallor ii.Abdominal distension 6.Hypoxia and shock could be caused by birth trauma. IX. Pathophysiology, Assessment, and Management of Cardiac Conditions in Newborns A.Pathophysiology 1.Congenital heart disease (CHD) a.Most common birth defect, occurring in 8 per 1,000 live births i.Approximately 1/3 are critical. ii.Accounts for approximately 40% of deaths caused by congenital anomalies b.Use pulse oximetry to detect oxygenated versus nonoxygenated blood. i.The highest sensitivity and highest specificity in monitoring is with the right hand and one foot. (a)Cutoff values of less than 95% or a greater than 3% difference between the two ii.Department of Health and Human Services and the American Academy of Pediatrics recommend pulse oximetry screening for full-term healthy newborns. c.Pulmonary stenosis: Pulmonic valve near the right ventricle becomes damaged. i.Patient will have a decrease in blood flow to the lungs and will present with: (a)Jugular vein distention
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(b)Cyanosis (c)Right ventricular hypertrophy ii.Typically associated with CHD d.Septal defects can exist in either the atrias or the ventricles. i.With an atrial septal defect (ASD), deoxygenated blood can shift from the right or left atrium to the other atria and mix with oxygen-rich blood. (a)May occur if the foramen ovale, which allows the fetus to receive oxygen-rich blood from the placenta, does not close after birth. (b)Hemodynamic status is dependent on how much blood flow is shunted. ii.In a ventricular septal defect (VSD), blood flows back into the right ventricle when the left ventricle contracts. (a)Causes an increase in the right ventricle pressure (b)Results in pulmonary hypertension e.Patent ductus arteriosus (PDA): The ductus arteriosus does not close after birth. i.Before birth, an open ductus arteriosus allows blood flow to bypass the right ventricle and lungs.
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