2. Peds/Neonates Flashcards
1
Q
narrowest part of airway
A
cricoid carilage
1
Q
RR
A
increased
2
Q
metabolic consumption
A
increased
6-8 mL/kg/min
3
Q
lung compliance
A
reduced
4
Q
chest wall compliance
A
increased
5
Q
FRC
A
reduced
6
Q
head/tongue
A
larger
7
Q
nasal passages
A
narrower
8
Q
larynx
A
anterior
cephalad
9
Q
epiglottis
A
longer
10
Q
trachea/neck
A
shorter
11
Q
adenoids/tonsils
A
more prominent
12
Q
intercostal/diaphragm muscles
A
weaker
13
Q
resistance to airflow
A
greater
14
Q
neonates and infants are obligate
A
nasal breathers
15
Q
CV is dependednt on
A
HR
16
Q
HR
A
increased
17
Q
BP
A
reduced
18
Q
LV
A
non-compliant
19
Q
CV summary: peds
A
1) HR-dependent CO
2) incr HR
3) reduced BP
4) non-compliant LV
5) residual fetal circulation
6) potential difficult venous/arterial cannulation
20
Q
BSA is _______
A
larger
21
Q
how do neonates warm themselves?
A
brown fat metabolism for nonshivering thermogenesis
22
Q
what inhibits brown fat metabolism
A
anesthesia
23
Q
BSA calculation
A
BSA = sqrt[(height x weight)/3600]
24
when does peds renal function normalize
6 months
25
peds glycogen
reduced which can cause hypoglycemia
26
peds drug dosing should be
allometric
27
50th percentile for weight
(Age x 2) + 9
28
neonate TBW
more than that of an adult
29
incr TBW =
incr volume of distribution of drug
== higher dosing needed
30
which pt population has highest anesthetic requirement for inhalational?
3 month olds
31
fast emergence can cause
incr risk of post-op delerium
32
volatile agent impact on myocardium
sensitizes myocardium to catecholamines
33
propofol infusion syndrome SE
HD instabolity
brady
hTN
green urine
34
propofol infusion most common pt
critically ill children
35
opioids peds
more pronounced effect due to immature mu receptors
36
remi dosing for peds
need to increase dosing due to incr clearance
37
dexmedetomidine nasal sedation dose
1-2 mcg/kg
38
muscle relaxants
NOT commonly used unless necessary
39
NDMB dosing
lower dosing due to immature NMJ
40
Roc IM dose
1-1.5 mg/kg
41
Roc IM onset
3-4 min
42
reversal options
1) neostigmine+glyco
2) edrophonium + atropine
**can use sugammadex
43
sugammadex SE
bradycardia
44
sux dosing
higher dosing
2-3 mg/kg
45
what should you give with sux
atropine
46
sux SE
arrhythmias
hyperkalemia
rhabdomyolysis
myoglobinemia
masseter spasm
MH
47
Sux + atropine IM dosing
sux IM: 4-6mg/kg
atropine: 0.02 mg/kg
48
what can incr risk of airway complications?
URTI
2nd hand smoke exposure
49
risk of aspiration
greater
50
risk of dehydration
greater
51
NPO: clear fluids
2 hrs
52
NPO: milk/formula
4 hrs
53
NPO: light meal
6 hrs
54
pre-meds
versed
ketamine
demedetomidine
fentanyl lollipops
versed + ketamine
55
versed IM
0.25mg/kg
56
versed oral
0.25-0.7 mg/kg
up to 20 mg
57
ketamine IM
4-6 mg/kg IM
w/atropine 0.02 mg/kg IM
58
dexmedetomidine nasal
1-2 mcg/kg nasal
59
versed+ketamine IM
versed: 0.1-0.15 mg/kg
ketamine: 2-3 mg/kg ketamine IM
60
mask induction speed
rapid
61
why is peds mask induction rapid?
high MV:FRC ration
incr CBF
decr B:G coefficient
62
induction mixutre
70% N2O
30% O2
63
steal induction
for agitated child
high flow
O2
N2O
8% sevo
64
common IV locations
saphenous
AC
hand
wrist
65
IO cannulation size
16-18g needle
66
how long can you use an IO for?
24 hours
67
IO CI:
fracture
burn
infection
osteogensis imperfecta
osteoporosis
previous IO attempt w/i 48hrs
recent sx on bone
68
IO sternum pt population
> 12 years old
69
IO cannulation sites
sternum
humerus
distal femur
proximal tibia
distal tibia
70
distal femur IO
1 cm prox to patella
1-2 cm medial
71
prox tibia IO
1-2 cm inferior and medial to tibial tuberosity
72
distal tibia IO
2cm prox to medial malleous
73
ETT meds
Naloxone
Atropine
Vasopressin
Epinephrine
Lidocaine
74
ETT med dosing
2-2.5x IV dose
dilute with 5-10 mL NS
75
what should you do after giving ETT meds
ventilate rapidly with large breaths
76
tube diameter
Age/4 + 4
77
tube length
Age/2 + 12
78
when do you use uncuffed ETT
greater than 4.0 size
79
peds ventilation
almost always mechanical
80
peds ventilator considerations
limit dead space
81
peds fluids management
4:2:1
goal directed therapy
82
buretrol
allows higher acuracy fluid admin
83
preterm neonate BV
100 mL/kg
84
full term neonate BV
85-90 mL/kg
85
infants BV
80 mL/kg
86
transfusion target critically ill
40%
87
PLT dose
10-15 mL/kg
88
FFP dose
10-15 mL/kg
89
cryo dose
1 unit/10kg weightcva
90
caudal dosing
2 mg/kg 0.25% marcaine w/epi
91
needle for caudal
22g
92
laryngospasm treatment
PPV
jaw thrust
propofol
lidocaine (1-1.5 mg/kg)
muscle relaxant
93
emergence positioning
rescue position
94
Croup treament
decadron
recemic epi
- 0.25-0.5 mL 2.25% in 2.5 mL NS
95
delerium risk factors
preschool
male
sevo/des
ENT
pre-op anxiety
parental anxiety
child temperment
96
deleriume prophylaxixs
precedex : 0.25-5 mcg/kg before wakeup
propofol bolus
reduced VA
