across the lifespan: pediatrics Flashcards by Sydney Elmore

epiglottitis versus laryngotracheobronchitis (croup) organism

epiglottitis: bacterial
croup: usually viral

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epiglottitis versus laryngotracheobronchitis (croup) age affected

epiglottitis: 2-6y
croup: <2y

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epiglottitis versus laryngotracheobronchitis (croup) onset (hours/days)

epiglottitis: rapid (<24h)
croup: gradual (24-72h)

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epiglottitis versus laryngotracheobronchitis (croup) region affected

epiglottitis: supraglottic structures (epiglottis, vallecula, aretynoids, aryepiglottic folds)
croup: laryngeal structures below cords

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epiglottitis versus laryngotracheobronchitis (croup) neck xray

epiglottitis: swollen epiglottis = thumb sign (lateral XR)
croup: supraglottic narrowing= steeple sign (front XR)

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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

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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

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inspiratory stridor presentation is most likely

croup

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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

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dose of racemic epi for child 0-20kg

.25mL of 2.25% racemic epi diluted in 2.5mL

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dose of racemic epi for child 20-40kg

.5mL of 2.25% racemic epi diluted in 2.5mL

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dose of racemic epi for child >40kg

.75mL of 2.25% racemic epi diluted in 2.5mL

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dose of racemic epi for child >40kg

.75mL of 2.25% racemic epi diluted in 2.5mL

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what age will you see post intubation laryngeal edema

<4y

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if you’ve given racemic epi, how long should you observe them before discharge

4 hours

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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

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presentation of subglottic obstruction

wheezing

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presentation of supraglottic obstruction

stridor

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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

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conditions associated with large tongue (and therefore difficult airway)

big tongue
beck with syndrome
trisomy 21

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conditions associated with small/ under developed mandible (and therefore a difficult aw)

please get that chin
pierre robin
goldenhar
treacher collins
cri du chat

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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

1. all structures distal to terminal bronchus begin developing after 16 weeks gestation 2. spontaneous fetal breathing begins as early as 11 weeks gestation 3. alveoli development begins immediately after birth 4. 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