10 day old neonatal boy presents to the ED in respiratory distress

Intubation and nasogastric tube placement

Intubation and nasogastric tube placement. A diaphragmatic hernia is a surgical emergency, requiring immediate intervention.  Most babies with diaphragmatic hernias are diagnosed prenatally, but there are a few cases that present postnatally.  These infants usually present in respiratory distress.  CXR will typically reveal loops of bowel within the thorax.  Diaphragmatic hernias occur more often on the left side of the chest, therefore displacement of the heart and left lung to the right side is commonly seen on XR.  Infants who present with respiratory distress and are found to have a diaphragmatic hernia should be endotracheally intubated to avoid excessive amounts of air accumulation in the bowel.  A nasogastric tube should be rapidly placed to decompress the stomach.  High flow oxygen will cause further bowel distention and may worsen respiratory distress.  An echocardiogram would be useful if the infant was in respiratory distress from a cardiac condition, but the exam and imaging is consistent with diaphragmatic hernia.  An IV will be useful for the infant, as he needs emergent surgery but neither the IV fluids nor septic workup will help his current respiratory distress. [F&L pp 50])