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RESP 5017 > 3. Neonatal and Pediatric Oxygen Therapy and Airway Management > Flashcards

3. Neonatal and Pediatric Oxygen Therapy and Airway Management Flashcards

1
Q

What are 3 oxygen therapy devices unique to paediatric populations?

A

oxygen hoods, incubator oxygen delivery, blow by oxygen

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2
Q

Flow (for nasal prongs) is based on what?

A

size of the patient

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3
Q

FiO2 for nasal prongs depends on the patients:

A

weight, tidal volume, RR, flow, FiO2 (set on blender)

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4
Q

Flow range for: premature, term, < 1 year, 1-4 years, > 4 years?

A

<0.2LPM, <0.5LPM, 0.2-2LPM, 0.5-3LPM, 0.5-6LPM

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5
Q

Incubator oxygen delivery has the ability to provide:

A

heat, humidity, and O2 therapy

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6
Q

What is the usual FO2 range with incubators?

A

23-40%

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7
Q

How is O2 delivered in an incubator?

A

incubator is connected to a 50psi O2 source and oxygen then floods the incubator to the set O2 concentration and is monitored by an internal O2 analyser

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8
Q

How is humidity added to oxygen hoods?

A

LVN

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9
Q

What are the set gas flows for oxygen hoods? What is the appropriate minimal flow to ensure CO2 clearance?

A

10-15LPM

minimum 7LPM

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10
Q

What MUST be monitored while using an oxygen hood?

A

SpO2, temperature, FiO2

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11
Q

What type of patients are oxygen hoods usually used for?

A

patients with thick&dry secretions - postextubation, RSV

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12
Q

List some anatomical differences in neonatal/paediatric airway.

A

occiput rounded, tongue relatively large for mouth/posteriorly placed, epiglottis omega-shaped and floppy, larynx higher in neck, vocal cords slant anteriorly, short neck, cricoid ring narrowest diameter, overall funnel shaped airway, narrow nares, larger adenoids/tonsils

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13
Q

What is the normal RR for a newborn?

A

40-60bpm

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14
Q

What is the normal minute ventilation of a newborn?

A

200ml/kg/min

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15
Q

What is the normal O2 consumption for a newborn?

A

6-8ml/kg/min

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16
Q

What is a normal compliance value for a newborn?

A

5-6ml/cmH2O

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17
Q

What is normal airway resistance for a newborn?

A

25-30cmH2O/L/sec

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18
Q

What are normal blood gas values for a premature neonate (< 37 weeks gestation)?

A

pH: > or equal to 7.25
PaCO2: 45-55
PaO2: 50-70
HCO3: 18-24

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19
Q

What are normal blood gas values for a term neonate (37 weeks - 1 month)?

A

pH: 7.30-7.40
PaCO2: 35-45
PaO2: 80-100
HCO3: 20-24

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20
Q

What are the normal blood gas values for a child to adult (> 1 year)?

A

pH: 7.35-7.45
PaCO2: 35-45
PaO2: 80-100
HCO3: 22-26

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21
Q

What are normal saturation levels for a premature newborn (< 37 weeks)?

A

90-94%

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22
Q

What are normal saturation levels for a term neonate (37 weeks-1 month)?

A

> or equal to 92%

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23
Q

What are normal saturation levels for a child to adult (1 month-18 years)?

A

> equal to 92%

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24
Q

What is the most common cause of airway obstruction in unconscious neonatal/pediatric patients?

A

tongue

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25
How can you optimize patient positioning for BVM/intubation?
offset the prominent occiput that promotes neck flexion/obstruction by placing a towel under the patients shoulders + perform a head tilt/chin lift *use jaw thrust in suspect C-spine injuries*
26
How do you size an OPA in children? What technique do you use to insert the OPA?
sized from the corner of the child's mouth to the angle of the jaw inserted using the anatomical technique
27
How is an NPA sized in children? When is an NPA contraindicated?
length approximated by distance from the tip of the nose to the tragus of the ear contraindicated in basal skull fracture or bleeding disorders
28
List some indications for BVM.
apnea, gasping, HR < 100 (newborn)/< 60 (pediatric), impending respiratory failure, impending cardiac failure, inadequate oxygenation and/or ventilation
29
List the 3 PPV devices for neonatal/pediatric popultions.
self-inflating bag, flow-inflating bag, T-piece resuscitator
30
Can a self-inflating bag be used to provide CPAP to a spontaneously breathing patient? Why/why not?
no, the outlet valve will not open and provide flow unless very high negative inspiratory pressure
31
What is the bag volume, age range, and weight range of a pediatric bag?
500-900ml, 1-10 years, 10-30kg
32
What is the bag volume, age range, and weight range of an infant bag?
250-350ml, < 1 year, < 10kg
33
What does a flow-inflating bag require? Can CPAP be applied?
requires a gas source and an adequate seal PEEP/CPAP can be applied and controlled by the flow coming into the bag (10 LPM) and how much gas is let out of the flow control valve
34
List some indications for intubation.
pulmonary function (apnea, bradycardia, resp. failure, resp. distress with inadequate oxygenation/ventilation), provide an airway (a/w obstruction, protect a/w, loss of a/w reflexes, decreased LOC/OD), pulmonary hygiene (inability to clear secretions), administer medications (surfactant, epinephrine)
35
What are the 3 main categories of drugs used for intubation?
sedative/analgesia, muscle relaxants, adjunctive therapies
36
Which medication is used to prevent bradycardia/secretion production?
atropine
37
What medications acts as an analgesics? Special considerations?
Fentanyl and morphine | *fentanyl needs to be pushed slowly (typically over 5 min)
38
Which medications can be use as paralytics? Depolarizing or Non-depolarizing?
succs (depolarizing), roc (non-depolarizing)
39
What is the acronym used when preparing for intubation? What does each letter stand for?
``` SOAP ME S - suction O - oxygen A - airway P - pharmacology ME - monitoring equipment ```
40
For a neonate weighing < 1000g and approx. < 28 weeks will require what type of ETT? Size? Blade type?
uncuffed, 2.5, Miller 00 or 0
41
For a neonate weighing 1000-2000g and approx. 28-34 weeks will require what type of ETT? Size? Blade type?
uncuffed, 3.0, Miller 0
42
For a neonate > 2000g and approx. > 34 weeks will require what type of ETT? Size? Blade type?
uncuffed, 3.5, Miller 0 or 1
43
How do you determine neonatal oral ETT depth?
measure nasal septum to the ear tragus (an add 1 cm) OR 6cm + weight in Kg *for nasal intubations add 1 cm to above methods
44
What is the recommended age to begin the use of cuffed ETT?
1 month +
45
What are the benefits of a cuffed ETT?
decrease the chance of aspiration, minimize leak around ETT to enhance ventilation
46
What is the optimal cuff pressure?
20-25cmH2O or MOV, but can also leave deflated if there is no leak
47
How do you determine the ETT size for UNCUFFED?
age (years)/4 + 4
48
How do you determine the ETT size for CUFFED?
Age (years)/4 + 3.5
49
How do you determine the oral ETT depth for children > 2 years?
ETT size x 3 OR age/2 + 12
50
How does a miller blade differ from a Mac blade?
miller blades directly pick up the epiglottis (floppy epiglottis in infants/children) vs. mac blade is placed in the valecula
51
What is the purpose of Broselow Tape?
length-based resuscitation tape used to determine sizes for airway equipment
52
List some ways in which an RT can confirm ETT placement.
visualization of ETT passing through vocal cords, bilateral BS, misting of ETT, bettering vital signs, end tidal CO2, CXR
53
What is the name of the method used to tape the ETT in children < 6 years?
pant leg method
54
What are the benefits of nasal intubation in infants?
easier securing of ETT, free mouth, better for long-term intubation
55
List some things that will make for a difficult intubation.
recessed jaw, large tongue, floppy epiglottis, small mouth opening, neck mobility, anterior vocal cords, congenital tracheal malformations, glottic stenosis, subglottic stenosis
56
List some indication for endotracheal suctioning.
abnormal BS, decreased SpO2, rattling in chest, abnormal ventilator waveforms, decreased/inadequate chest rise, agitation
57
Describe the open vs closed method used for endotracheal suctioning.
open - use of a regular suction catheter | closed - inline (Ballard style)
58
What are the suction pressures for a neonate/infant vs. child?
neonate/infant - 80-100mmHg | peds - 100-120 mmHg
59
To what depth should an RT suction down a ETT?`
1/2 cm past the end of ETT | *line up color markings on suction catheter with window
60
In the case of a sudden event post-intubation, what is the acronym used to find the problem? What does each letter stand for?
``` H-DOPE H - handbag/auscultate D - displacement O - obstruction P - pneumothorax E - equipment ```

RESP 5017 (19 decks)

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