across the lifespan: pediatrics Flashcards
epiglottitis versus laryngotracheobronchitis (croup) organism
epiglottitis: bacterial
croup: usually viral
epiglottitis versus laryngotracheobronchitis (croup) age affected
epiglottitis: 2-6y
croup: <2y
epiglottitis versus laryngotracheobronchitis (croup) onset (hours/days)
epiglottitis: rapid (<24h)
croup: gradual (24-72h)
epiglottitis versus laryngotracheobronchitis (croup) region affected
epiglottitis: supraglottic structures (epiglottis, vallecula, aretynoids, aryepiglottic folds)
croup: laryngeal structures below cords
epiglottitis versus laryngotracheobronchitis (croup) neck xray
epiglottitis: swollen epiglottis = thumb sign (lateral XR)
croup: supraglottic narrowing= steeple sign (front XR)
epiglottitis versus laryngotracheobronchitis (croup) clinical presentation
epiglottitis: high grade fever, tripod position, 4 d’s (drooling, dyspnea, dysphonia, dysphagia)
croup: low grade fever, barking cough, vocal hoarseness, inspiratory stridor, retractions
epiglottitis versus laryngotracheobronchitis (croup) treatment
epiglottitis: urgent aw management (tracheal intubation, tracheostomy), abx if bacterial, induction with spontaneous RR (CPAP 10-15cmH2O to prevent aw collapse), ENT surgeon must be present, postop ICU care
croup: O2, racemic epi, corticosteroids, humidification, fluids, intubation rarely required
inspiratory stridor presentation is most likely
croup
preferred tx for post intubation laryngeal edema (post intubation croup) and other tx’s
racemic epi preferred
cool and humidified O2, dexamethasone .25-.5mg/kg IV, heliox (mixture of O2 and helium) reduces raynauds number
NO abx, its not infectious
dose of racemic epi for child 0-20kg
.25mL of 2.25% racemic epi diluted in 2.5mL
dose of racemic epi for child 20-40kg
.5mL of 2.25% racemic epi diluted in 2.5mL
dose of racemic epi for child >40kg
.75mL of 2.25% racemic epi diluted in 2.5mL
dose of racemic epi for child >40kg
.75mL of 2.25% racemic epi diluted in 2.5mL
what age will you see post intubation laryngeal edema
<4y
if you’ve given racemic epi, how long should you observe them before discharge
4 hours
good reason to cancel elective surgery: child presentation
purulent nasal drainage
fever >38c
lethargic
persistent cough
poor appetite
wheezing and rales that do not clear with cough
child <1y or previous preemie
presentation of subglottic obstruction
wheezing
presentation of supraglottic obstruction
stridor
choice of anesthesia for a patient who has a possible foreign body onstruction
inhalation induction with spontaneous RR
also TIVA may be best or addition of propofol because there will be a leak around the rigid bronchoscope
conditions associated with large tongue (and therefore difficult airway)
big tongue
beck with syndrome
trisomy 21
conditions associated with small/ under developed mandible (and therefore a difficult aw)
please get that chin
pierre robin
goldenhar
treacher collins
cri du chat
conditions associated with cervical spine anomaly (and therefore a difficult aw)
kids try gold
klippel feil
trisomy 21
goldenhar
pathophysiologic anatomy of pierre robin
small/under developed mandible
tongue that falls down and backwards (glossoptosis)
cleft palate
neonate often requires intubation
pathophysiologic anatomy of treacher collins
small mouth
small/under developed mandible
choanal atresia (nasal blockage of tissue)
ocular and auricular anomalies
pathophysiologic anatomy of trisomy 21
small mouth
large tongue
Atlanto axial instability
sublottic stenosis
pathophysiologic anatomy of klippel feil
congenital fusion of neck vertebrae which causes neck rigidity
pathophysiologic anatomy of goldenhar
small/under developed mandible
cervical spine abnormality
pathophysiologic anatomy of beck with syndrome
large tongue
pathophysiologic anatomy of cri du chat
small/under developed mandible
laryngomalacia
stridor
airway specific risks of patient with cleft lip and palate include
airway obstruction
difficult laryngoscopy
difficult mask ventilation
aspiration
first and second most common cardiac anomalies associated with down syndrome
first: atrioventricular septal defect
second: VSD
VACTERL
vertebral defects
imperforated Anus
cardiac anomalies
tracheoesophageal fistula
esophageal atresia
renal dysplasia
limb abnormalities
CHARGE association
Coloboma
heart defects
choanal atresia
restriction of growth and development
GU problems
ear anomalies
catch 22
Cardiac defects
abnormal face
thymic hypoplasia
hypocalcemia (d/t hypoparathyroidism)
22 (22q11.2 gene deletion- cause of syndrome)
aka DiGeorge
tx for DiGeorge
thymus transplant or mature T cell infusion
type of blood to transfuse to DiGeorge patient
transfusion of leukocyte depleted irradiated blood
most common coagulation DO in patients undergoing adenotonsillectomy
vWF (administer DDAVP and decrease hourly rate to 1/2 or 1/3 of normal r/t HoNatremia then monitor postop sodiums)
anesthetic management of patient with OSA under going adenotonsillectomy
emergence is slower, tx like any other OSA patient (less opioids)
dont give codeine for postop pain
monitor post procedure for 23h
how to oxygenate child actively bleeding from adenotonsillectomy
pre oxygenate in left lateral and head down position
RSI and OGT hoe, blood in tummy. i repeat, blood in tummy.
most common indication for liver transplantation in children less than 2 years of age?
s/sx
tx
biliary atresia
s/sx: persistent jaundice >14d, dark urine, acholic stool (pale or clay colored), hepatomegaly, splenomegaly
surgical correction: kasais operation (portoenterostomy), liver transplant
how to combat the following for kids during surgery:
conduction
evaporation
radiation
conduction: place a foam pad on OR table
evaporation: humidify anesthetic gases
radiation: cover head with plastic (where they lose most of their heat)
what does the fetal nicotinic receptor include
gamma, delta, beta, and 2 alpha sub units
in the neonate, what are the most reliable indicators of recovery from NMB
flexion of knees to chest and a maximum inspiratory force > -25cmH2O
match the following respiratory component developments to their timeline:
1. all structures distal to terminal bronchus begin developing
2. spontaneous fetal breathing begins
3. alveoli development begins
4. bronchial tree proximal to the terminal bronchus begin developing
- all structures distal to terminal bronchus begin developing after 16 weeks gestation
- spontaneous fetal breathing begins as early as 11 weeks gestation
- alveoli development begins immediately after birth
- bronchial tree proximal to the terminal bronchus begin developing before 16 weeks gestation
what conditions are associated with childhood obesity
asthma
HTN
OSA
(not RVH)
most sensitive indicator of positive test dose in anesthetized child receiving IV epi test dose is
peaked t wave (then increased SBP then increased HR)
in an infant, what risks are associated with bronchiopulmonary dysplasia on induction
intraop bronchospasm, subglottic narrowing
inhalation agents respond more rapidly in children than adults. why is this
increased distribution of CO to vessel rich group
increased alveolar ventilation to FRC ratio
disadvantages of brachial arterial catheter cannulation in pediatric patient includes
risk of median nerve injury
poor collateral BF
indications for leukocyte reduced blood component administration in children
prevention of leukocyte alloimmunization
decreasing risk of CMV transmission
the oculocardiac reflex most often manifests
as brady cardia or sinus arrest
what signs are typically present in a child with intrathoracic airway obstruction
prolonged expiration
expiratory stridor
what actions are favored in the anesthetic management of a pediatric patient with a cleft palate
perform awake extubation
introduce ring adair elsyn (RAE) tube into trachea
