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Case Discussion

Case Discussion. Ryan Surmaitis FOEM CPC Competition. Diagnosis. You order a…. Chest X-ray. Congenital Diaphragmatic Hernia. Emergency Medicine Relevance. Life-threatening Neonates and infants Diagnosis is easy with simple CXR Correct early management can prevent death.

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Case Discussion

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  1. Case Discussion Ryan Surmaitis FOEM CPC Competition

  2. Diagnosis • You order a…. Chest X-ray

  3. Congenital Diaphragmatic Hernia

  4. Emergency Medicine Relevance • Life-threatening • Neonates and infants • Diagnosis is easy with simple CXR • Correct early management can prevent death

  5. Congenital Diaphragmatic Hernia • Congenital defect • Abdominal viscera  diaphragm  chest

  6. CDH Occurrence • 1:3000 live births • 50% antenatal • 25% neonates • 15% infants/children • 10% in adulthood

  7. CDH Occurence • Case report: 78 year old man diagnosed with congenital diaphraghmatic hernia

  8. Pathophysiology • Defect in diaphragm formation (6-14 weeks) • Occurs during critical period in lung development • Pulmonary Hypoplasia • Pulmonary Hypertension

  9. Pathophysiology Bochladek • More common • More lethal • Posterolateral • Left-sided Morgani • More rare • Anterior

  10. Presentation • Respiratory Distress • Tachypnea • Grunting • Retractions • Cyanosis • Heart sounds shifted to R side of chest • Absent or decreased breath sounds on side of herniation • Bowel sounds in chest

  11. Diagnosis Keys for making diagnosis • Needs to be in your differential 2. Imaging of chest

  12. Chest X-ray • Loops of bowel in chest • Heart and mediastinum displaced to right • Hypoplastic lungs • Atelectasis • Nasogastric tube in hemithorax

  13. Treatment in ED • Severe respiratory distress • ABC’s • Intubate early • Resuscitate • Place NG tube • Contact appropriate services (surgery/PICU)

  14. Outcome • Pt respiratory distress resolved in ED • Admitted to Peds • Respiratory distress overnight requiring intubation • Taken to OR the next day • Recovered and out of hospital 5 days later

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