1. Peds Flashcards
full term
37-41 weeks gestational age
preterm
< 37 weeks
Small for gestational age
birth weight < 10th %
Large for gestational age
birth weight > 10th %
embryonic lung development
4-7 weeks gestation
psuedoglandular lung development
5-17 wks gestation
canalicular lung development
16-26 wks gestation
saccular lung development
24 wks to birth
alveolar lung development occurs
after birth to 3 years
when does the bronchial tree develop?
pseudoglandular stage
when does the differentiation of type 1 and type 2 surfactant occur?
canalicular stage
when is surfactant mature?
saccular stage
how many alveoli at birth?
30-50 million
amniotic fluid function
protects baby
fetal breath movements (FBM)
pulls fluids into lungs
opens alveoli
stimulates growth
amniotic fluid contains
urine and lung secretions
fetal blood from IVC flows
through foramen ovale
fetal blood from SVC flows
through trucsupid
fetal lungs PVR
higher due to HPV
fetal circulation is _____ while adult circulation is ______
fetal circulation is 2 parallel circuits while adult circulation is 1 circuit in series
umbilical arteries carry
deoxy blood
umbilical vein carry
oxy blood
umbilical vein PO2
55 mmHg
fetal hb subunits
2 alpha
2 delta
fetal hb p50
19 mmHg
fetal hb-o2 shift
Left Shift
what happens to BF through PDA at birth
decr SVR causes BF to bypass PDA
what closes PFO
incr pulm circulation
incr LA P
how do you avoid baby hypoxia at birth
delayed cord clamping
infant ribs/diaphragm
parallel ribs
flatter diaphragm
compensate by incr RR
infants response to CO2
decr ventilatory response
infants response to hypoxic mixture
incr ventilation for 1 min
5 min hyponea
infants response to hypoxic mixture due to
immature carotid bodies
infant respiratory diffferences
decr TLC
decr TV
decr FRC
incr O2 consumption
incr MV
incr closing capacity (incr atelectasis risk)
infant diaphragm compostion
25% type 1 aerobic muscle fibers means they need mechanical ventilation help bc tire easily
infant airway differences
larger tongue
cephalad larynx
narrow omega epiglottis
angled vocal cords
narrowest part of infant airway
cricoid cartilage
level of glottic opening: preterm infant
C3
level of glottic opening: fulterm infant
C3-C4
level of glottic opening: adult
C4-C5
pediatric SV
fixed due to non-compliant LV
pediatric CO
HR-dependent
are peds pts parasympathetic or sympathetic dominant?
parasympathetic
peds renal drug elimination
decr renal drug elimination
incr DOA
peds urine
dilute
Cr at birth
same as mother
Cr 48 hrs post-birth
0.5 mg/dL
[Hg] at birth
19 g/dL
HgF at birth
70%
why is peds Hg so high?
incr EPO
cranial sutures
elastic tissue bands
- fontanels at junction of cranial sutures
anterior fontanel closes
20 months
posterior fontanel closes
3 months
which drug is neuroprotective
dexmedetomidine
which drugs do not cause neuroapoptosis
narcots
PANDA study
no sig difference in IQ when exposed to anesthetics
GAS study
no diff in neurodevelopment at 5 yrs
Mask Study
no statistica difference between kids w or w/o anesthetic exposures
risk of anesthesia in peds incr with
longer duration
increased frequency
peds drugs with hepatic metabolism
longer DOA
fentayl metabolism by newborn
50%
full-term neonate glycogen
similar to adults
peds oral midazolam dosing
0.3-0.7 mg/kg
oral midazolam onset
10 mins
peds precedex doing
2 mcg/kg
peds precedex onset
20-30 mins
how should you dose peds
based off of ideal body weight
IBW
IBW = 2*age +10
neonate -12 mo mask size
2
12 mo - 4 yr mask size
3
4-12 yr mask size
4
12+ yr mask size
5
uncuffed ETT
age/4 + 4
cuffed ETT
age/4 + 3.5
ETT depth
3* ID
where does uncuffed tube seal
at cricoid
improper tube sizes can cause
edema due to incr resistance
LMA 1
<5 kg
LMA 1.5
5-10 kg
LMA 2
10-20 kg
LMA 2.5
20-30 kg
LMA 3
females over 30 kg or 10 yrs
LMA 4
males over 30 kg or 10 years
which airway has decr laryngospasm
LMA
infants < 3 warming mechanism
non-shivering thermogenesis via brown fat metabolism
how to manage peds temperature
warm room
warm IV fluids
forced air warmers
airway humidification
most common cause of ped cardiac arrest
respiratory compromise
sunken fontanel can indicate
hypovolemia
respiratory disress syndrome
preterm infant born w/Type 2 pneumocyte deficiency
delayed surfactant production
50% surfactatn by 28 weks
100% by 36 weeks
risk in RDS pts
pneumothorax
bronchopulmonary dysplasi
alveolar hyperplasia
arrest of alveolar development
pts in bronchopulmonary dysplasia need
supp O2 for at least 28 days after birth
O2 dependenc at 36 weeks PCA
what should you avoid unless absolutely necessary in bronchopulmonary dysplasia pts
intubation
laryngomalaci
flaccidity or laryngeal structures corrected with supraglottoplasy
laryngomalacia managment
CPAP
PPV
bronchomalacia
weakened cartilage of major airways causing airway collapse
bronchomalacia respiratory disease type
expiratory with PPV
inspiratory wtih SV
what anesthetic is used for diagnosis of laryngomalacia and bronchomalacia
bronchoscopy with TIVA
airway decadron dose
0.5 mg/kg
adenotonsillar hypertrophy causes
congenital
chronic tonsillitis
what should you not give adenotonsillar hypertrophy pts
midazolam
avoid toradol
primary bleeding tonsil timeline
24 hrs post surgery
secondary bleeding tonsil timeline
days 5-7 or 10-14
anesthetic for drug induced sleep endoscopy
1-2 mcg/kg precedex
apnea of prematurity
cessation of breathing > 20 seconds
SaO2 < 90%
APO treatment
nasal CPAP
caffeine
aminophylline
congenital diaphragmatic hernia triad
dyspnea
cyanosis
dextrocardia
most common type of CDH
bochdalek
CDH treatment
intubate after birth
SaO2 > 90%
2 pulse ox
avoid PPV
where are pulse ox placed CDH
pre-ductal: arm
post-ductal: foot
where is art line placed CDH
right upper extremity
low delta in pulse ox CDH
open PDA
high delta in pulse ox CDH
closed PDA
most common congenital anomaly of esophagus
esophageal atresia type C
esophageal atresia s+s
choking/aspiration
coughing
cyanosis
excessive salivation
VACTERL
(tracheoesophageal fistula)
Vertebral anomalies/VSD
Anorectal malformation
Cardiac anomalies
TEF
Esophageal atreasia
Renal abnormalities
Limb/radial malformation
TEF
fully developed respiratory system where esophagus connects to trachea
TEF B/D/E
upper esophagus connects to trachea
TEF C/D/E
acid from stomach goes into trachea
TEF management
spontaneous ventilation
omphalocele
bowel contained in sac
gastroschisis
bowel not contained in sac
gastroschisis fluid losses
100-200 mL/kg/hr
hirshprungs disease
aganglionic megacolon
stool buildup
pyloric stenosis causes
projectile vomiting
pyloric stenosis is a
medical emergency cannot get fluids in
volvulus
bowel obstruction that twists upon itself
volvulus is a
surgical emergency
causes sepsis if not treated
biliary atresia
inflammation of bile ducts causing obliteration of extrahepatic biliary tract
biliary atresia diagnosis
persistent jaundice
biliary atresia causes
cirrhosis
kasai procedure
surgical removal of blocked duct
anastamosis of small bowel onto intrahepatic bile duct
pts require what after kasai procedure
50% require liver transplant
pectus excavatum causes
restrictive lung disease
pectus excavatum PFTs
decr capacity
incr pressure
what corrects pectus excavatum
nuss procedure
necrotizing enterocolitis
life threatening intestinal inflammation or injury
bacterial infection to affected bowel
CP pts require
lower MAC
CP pts have ______ emergence
delayed
CP pts are sensitive to
precedex
vagal nerve stimulators are
turned off before surgery
hydrocephalus
CSF acumulation due to imbalance of CSF production/reabsorption
hydrocephalus prcedure
VP-shunt
spina bifida
fetal malformation with protrusion of spinal cord and meninges in spinal column defect
when is spina bifida treated
w/i 24 hrs of birth
spina bifid lifelong deficits
neurogenic bowel
neurogenic bladder
lower extremity sensory/motor loss
main concern during myelomeningocele repair
avoid compressure of defect during airway manipulation
cranyosynostosis
premature closure of cranial sutures
incr ICP
cranyosynsostosis pt posiitonin
sphynx
spinal muscular atrophy treatment
spinarza
zolgensma
what should you avoid in SMA
sux
caution with opiods and NMD
ped difficult airways
pierre-robin
goldenhar
treacher collins
apert syndrome
crouzon syndrome
beck with wiedemann
downs
freeman sheldon
klippel feil
pfeiffer
pierre robin triad
micrognathia
glossoptosis
airway obstruction
goldenhar
hemifacial microsomia
treacher collins
madibular dystosis
receding chin
apert
autosomal dominant
crouzon
craniofacial dystosis
malformation of face and skill
spica cast
used to imobilie one or both lower exrremities
most common genetic diseas in children
trisomy 21
trisomy 21
cardiac anomalies
OSA
hypotonia
ligamentum laxity
trisomy pts cannot
extend neck due to atlantoaxial instability
trisomy pts ETT
smaller glottic opening
0.5 smaller ETT
trisomy pts reaction on inhalational induction
bradycardic
