Apex Unit 11 Across the Lifespan Flashcards
A patient requires an emergency cesarean section. Which of the following is the MOST likely cause for rapid arterial oxygen desaturation during intubation?
Increased residual volume
Decreased vital capacity
Increased inspiratory reserve capacity
Decreased expiratory reserve volume
Decreased expiratory reserve volume
By now you should know that an increased oxygen consumption relative to FRC contributes to rapid arterial desaturation in the obstetric patient.
You had to choose between several lung volumes and capacities. You probably knew that FRC declines, but quickly realized that FRC was not listed. The next course of action should have been to think about the determinants of FRC (RV + ERV).
Eureka! Expiratory reserve volume is reduced, which decreases FRC and this increases the rate of desaturation during apnea.
Which hemodynamic variables increase during pregnancy? (Select 2.)
Systemic vascular resistance
Heart rate
Stroke volume
Pulmonary artery occlusion pressure
Heart rate
Stroke volume
You need to understand how normal physiology changes for each special population: OB, peds, and the elderly. It’s a fool’s errand to attempt to memorize all of these changes without understanding why each occurs.
Stroke volume is increased as a function of increased intravascular volume, while heart rate is increased to satisfy a higher metabolic demand.
In the vascular smooth muscle, increased progesterone stimulates NO release. This reduces SVR. A dilutional anemia also contributes to the reduction in SVR.
PAOP is unchanged.
Which factors are expected to increase during pregnancy? (Select 3.)
Sensitivity to local anesthetics Urine glucose MAC Lower esophageal sphincter tone Gastric pH Creatinine clearance
Creatinine clearance
Urine glucose
Sensitivity to local anesthetics
Creatinine clearance increases as a function of increased intravascular volume and cardiac output - more creatinine is delivered to the kidney per unit time. Creatinine and BUN are decreased.
Urine glucose increases as a result of increased GFR and reduced reabsorption into the peritubular capillaries.
Increased progesterone explains the increased sensitivity to local anesthetics. This also decreases MAC by 30 - 40 % and reduces lower esophageal sphincter tone.
Increased gastrin reduces gastric pH.
Uterine blood flow is: (Select 2.)
20% of the cardiac output.
reduced by phenylephrine.
not autoregulated.
700 mL/min.
700 mL/min
Not autoregulated
Key facts about uterine blood flow:
At term, uterine blood flow increases to 700 mL/min.
UBF is not autoregulated - it is dependent on maternal MAP, cardiac output, and uterine vascular resistance.
UBF is 10% of the cardiac output (not 20%).
UBF is not reduced by phenylephrine. Use of phenylephrine instead of ephedrine is associated with a higher fetal blood pH. Both drugs are acceptable agents to use in obstetrics.
Which stage of labor begins with the onset of perineal pain?
Latent stage
Active stage
First stage
Second stage
Second stage
There are three stages of labor:
The first stage begins with cervical dilation with regular uterine contractions and ends with full cervical dilation (10 cm). It can be divided into the latent phase and the active phase.
The second stage begins with full cervical dilation and ends with delivery of the newborn.
The third stage begins with the delivery of the newborn and ends with the delivery of the placenta.
All of the following are appropriate for pain relief during the first stage of labor EXCEPT a/an:
paravertebral sympathetic lumbar block.
pudendal block.
epidural block.
paracervical block.
Pudendal block
The perineum is innervated by the pudendal nerve, which derives from S2-S4. This explains why a pudendal nerve block is not useful during the first stage of labor (T10-L1).
During the second stage, the uterus is still contracting and the cervix is fully dilated. For this reason, T10-S4 will need to be anesthetized to adequately treat labor pain.
Which local anesthetic reduces the efficacy of epidural morphine?
Levobupivacaine
Etidocaine
Ropivacaine
2-Chloroprocaine
2-Chloroprocaine
This is one of those questions that may sound like trivia, however it’s important stuff for boards.
2-Chloroprocaine antagonizes mu and kappa receptors in the spinal cord. This reduces the efficacy of epidural morphine. There are no other local anesthetics that do this.
Fifteen minutes after a patient’s epidural was dosed, the patient becomes hypotensive and experiences respiratory arrest. What is the MOST likely etiology?
Subdural injection
Epidural catheter migration
Loss of accessory respiratory muscle strength
Eclampsia
Subdural injection
This patient has experienced a total spinal. Due to the time course, the most likely explanation is a subdural injection.
According to the American College of Obstetrics and Gynecologists, which of the following are predictive of poor fetal status? (Select 2.)
Absent baseline variability
Sinusoidal pattern
No late or variable decelerations
Bradycardia without absence of baseline variability
Sinusoidal pattern
Absent baseline variability
Match each serum magnesium concentration with its expected clinical effect.
1 mg/dL
5 mg/dL
8 mg/dL
15 mg/dL
Respiratory depression
Loss of patellar tendon reflex (deep tendon reflex)
Seizures
Drowsiness
1 mg/dL + Seizures
5 mg/dL + Drowsiness
8 mg/dL + Loss of patellar tendon reflex (deep tendon reflex)
15 mg/dL + Respiratory depression
Anesthetic considerations for the use of methergine include:
IV administration.
risk of water intoxication.
administration of 0.2 mg.
tocolysis.
Administration of 0.2 mg
The dose of IM methergine is 0.2 mg. It should always be given IM, as IV administration can result in severe hypertension, particularly in the patient with preeclampsia.
Methergine is an uterotonic drug (it increases contractility). It is not a tocolytic (uterine relaxant).
There is a risk of water intoxication with oxytocin (not methergine).
Anesthetic implications for cesarean section under general anesthesia include:
rapid sequence induction.
administration of a dopamine agonist.
increased MAC.
prolonged neonatal respiratory depression.
Rapid sequence induction
In this patient population, mortality is 17-times higher with a general anesthetic. Avoid it whenever possible! Failure to successfully manage the airway is the most common cause of maternal death.
An obstetric patient at 33-weeks gestation requires a laparoscopic appendectomy. Which drug should be avoided?
Ketorolac
Morphine
Succinylcholine
Propofol
Ketorolac
After the first trimester, NSAIDs can close the ductus arteriosus.
While no anesthetic is a proven teratogen in humans, it’s wise to stick with drugs with a long track record of safety such as: propofol, opioids, neuromuscular blockers, and inhalation agents.
Which signs are consistent with a diagnosis of preeclampsia? (Select 3.)
Vasoconstriction Increased thromboxane Impaired platelet aggregation Increased prostacyclin Seizures Proteinuria
Increased thromboxane
Vasoconstriction
Proteinuria
Preeclampsia is associated with increased thromboxane, vasoconstriction, and proteinuria. These patients also have enhanced platelet aggregation (not impaired) and decreased prostacyclin (not increased).
The patient with eclampsia has seizures, while the patient with preeclampsia does not - although she is at risk.
Match each placental deformity to its description.
Placenta previa
Placenta accreta
Placenta increta
Placenta percreta
Placenta invades the myometrium
Placenta extends beyond the uterus
Placenta attaches to the surface of the myometrium
Placenta covers the cervical os
Placenta previa + Placenta covers the cervical os
Placenta accreta + Placenta attaches to the surface of the myometrium
Placenta increta + Placenta invades the myometrium
Placenta percreta + Placenta extends beyond the uterus
What is the MOST common cause of postpartum hemorrhage?
Retained placenta
Disseminated intravascular coagulopathy
Uterine inversion
Uterine atony
Uterine atony
Uterine atony is the most common cause of postpartum hemorrhage.
Other causes of postpartum hemorrhage include:
Retained placenta
DIC
Uterine inversion
Five minutes following delivery, a newborn has an irregular respiratory rate with a heart rate of 105. He is grimacing, has some flexion in the extremities, and has a pink body with blue extremities. Calculate his APGAR score.
6
The Apgar score is used to assess the newborn and guide resuscitative efforts. Five parameters are evaluated at one and five minutes after delivery.
The score at one minute correlates with fetal acid-base status.
The five minute score may be predictive of neurologic outcome.
This newborn has an Apgar score of 6 (1 + 2 + 1 + 1 + 1 = 6).
Each vital sign is consistent with the term newborn EXCEPT:
diastolic blood pressure 40 mmHg.
heart rate 140 bpm.
respiratory rate 40 bpm.
systolic blood pressure 90 mmHg.
Systolic blood pressure 90 mmHg
The SBP in the newborn is ~ 70 mmHg.
A neonate with a SBP > 80 mmHg is hypertensive.
The rest of the vital signs are textbook examples of normal:
DBP = 40
HR = 140
RR = 40
Select the statements that MOST accurately reflect the cardiovascular system in the newborn. (Select 2.)
Heart rate is the primary determinant of blood pressure.
Hypotension is defined as systolic blood pressure < 70 mmHg.
Phenylephrine is a first line treatment for hypotension.
Stress is more likely to activate the parasympathetic nervous system.
Heart rate is the primary determinant of blood pressure
Stress is more likely to activate the parasympathetic nervous system
Heart rate is the primary determinant of both cardiac output and blood pressure. The ANS is immature, and there is a predominance of the PNS. Stress is likely to cause bradycardia, which in turn reduces cardiac output.
In the newborn, hypotension is defined as SBP < 60 mmHg (not < 70 mmHg).
Neonates have a poorly compliant ventricle, so they are unable to significantly increase contractility to overcome an elevated afterload. This makes phenylephrine a poor choice for the treatment of hypotension. As you will see later, however, there are instances where phenylephrine is useful for the neonate.
Which statement MOST accurately describes the infant airway? (Select 3.)
Epiglottis is floppy
C shaped epiglottis
Vocal cord position at C1-C2
Right and left mainstem bronchi take off at same angle
Vocal cords have anterior slant
Glottic opening is positioned more cephalad
Glottic opening is more cephalad
Vocal cords have an anterior slant
Right and left mainstem bronchi take off at the same angle
Here’s why the distractors were wrong:
The vocal cord position is at C3-C4 (not C1-C2).
The epiglottis is U or omega shaped (not C).
The epiglottis is long and stiff (not floppy). Anyone who says the epiglottis is floppy has clearly never intubated a neonate!
During an inhalation induction, a neonate begins to desaturate shortly after removal of the facemask. Which statement BEST explains why the neonate desaturated so quickly?
Increased alveolar ventilation to FRC ratio
Oxygen consumption is 3 mL/kg/min
The patient is experiencing malignant hyperthermia
Decreased alveolar ventilation to FRC ratio
Increased alveolar ventilation to FRC ratio
The oxygen consumption in the neonate is nearly twice that of the adult.
Neonate ~ 6 mL/kg/min
Adult = ~ 3.5 mL/kg/min
Because the neonate has a higher ratio of alveolar ventilation relative to the size of her FRC, the oxygen supply contained within the FRC is quickly depleted. This makes her desaturate comparatively faster during apnea.
While an inhalation agent could theoretically precipitate MH, and this would significantly increase oxygen consumption, this is not the most likely cause of desaturation in the patient detailed in this question.
When compared to the adult, select the true statements regarding the pulmonary system in the newborn. (Select 2.)
The diaphragm has more type II than type I muscle fibers.
Neonates have the same amount of dead space on a per weight basis.
The diaphragm has more type I than type II muscle fibers.
The newborn has a higher tidal volume on a per weight basis.
The diaphragm has more type II than type I muscle fibers
Neonates have the same amount of dead space on a per weight basis
The diaphragm has more type II (fast twitch) fibers and less type I (slow twitch) fibers. Because of this, neonates are more likely to experience respiratory fatigue.
Neonates and adults have the same amount of dead space (2 mL/kg).
The newborn has the same tidal volume as the adult (6 mL/kg), however it has a much higher respiratory rate to support its high alveolar ventilation requirement.
When compared to the adult, which statement presents the MOST accurate understanding of neonatal pulmonary mechanics? (Select 2.)
Airflow resistance during tidal breathing is decreased.
Chest wall compliance is increased.
Closing capacity is increased.
Residual volume is decreased.
Closing capacity
Chest wall compliance is increased
On a per weight basis, closing capacity is increased in the neonate. When closing capacity overlaps with tidal volume, the neonate is at risk for V/Q mismatching in favor of shunting.
Chest wall compliance is increased due to a cartilaginous ribcage that provides less structural support.
Airflow resistance is increased (not decreased). Remember that, during laminar flow, resistance is inversely proportional to the radius raised to the 4th power.
Residual volume is increased (not decreased).
Select the data set that MOST accurately depicts a normal umbilical artery blood gas.
pH = 7.40 PaO2 = 90 PaCO2 = 30
pH = 7.20 PaO2 = 50 PaCO2 = 50
pH = 7.30 PaO2 = 20 PaCO2 = 50
pH = 7.35 PaO2 = 30 PaCO2 = 40
pH = 7.30 PaO2 = 20 PaCO2 = 50
The umbilical arteries return deoxygenated blood from the fetus to the placenta, so it should make sense that this blood has a low PaO2 and an elevated PaCO2.
Know and understand the following reference ABGs:
Umbilical vein (to the fetus): pH = 7.35 PaO2 = 30 PaCO2 = 40
Umbilical arteries (to the placenta): pH = 7.30 PaO2 = 20 PaCO2 = 50
First 10 min of life: pH = 7.20 PaO2 = 50 PaCO2 = 50
Mother at term: pH = 7.40 PaO2 = 90 PaCO2 = 30
Before moving to the next page, where we’ll explain all of this to you, take a moment and see if you can reason it out.
Which statement regarding fetal hemoglobin is TRUE?
It has an increased affinity for 2,3-DPG.
It has a higher P50 than the adult.
It is replaced by hemoglobin A at 9 months of age.
Erythrocytes containing hemoglobin F have a shorter lifespan.
Erythrocytes containing hemoglobin F have a shorter lifespan
Key facts regarding fetal RBCs and HgbF:
Fetal RBCs have a lifespan of 70 – 90 days, which is shorter than those with HgbA (120 days).
HgbF has a P50 value of 19 mmHg, which is lower than the adult value of 26.5 mmHg.
HgbF is unable to bind 2,3-DPG, which explains why it has a higher affinity for oxygen.
HgbF is replaced by RBCs containing Hgb A in the first two months of life.
Potential complications of massive transfusion in the neonate include all of the following EXCEPT:
metabolic acidosis.
hypokalemia.
hypocalcemia.
metabolic alkalosis.
Hypokalemia
Massive transfusion is associated with hypocalcemia, metabolic acidosis, and/or metabolic alkalosis.
Neonates and children who receive erythrocyte transfusion are at risk for hyperkalemia (not hypokalemia).
A 3-kg term neonate requires emergency exploratory laparotomy for necrotizing enterocolitis. Her preoperative hematocrit is 50%. What is the maximum allowable blood loss to maintain a hematocrit of 40%?
(Enter your answer as mL)
48 - 60 mL or 53 - 67 mL (we accepted the wider range)
The “correct” range is a function of the equation you use (there are two common ones). We like the following equation:
MABL = EBV x [(Hct starting - Hct target) / Hct starting]
If you used this equation, the correct range is 48 - 60 mL.
The other equation uses Hct average in the denominator:
MABL = EBV x [(Hct starting - Hct target) / Hct average]
If you used this equation, then the correct range is 53 - 67 mL.
For your exam, the item writers should be aware of the different equations in the texts and take this into account when determining the correct response to the question.
The newborn’s kidney tends to:
reabsorb water.
reabsorb glucose.
reabsorb sodium.
excrete sodium.
Excrete sodium
The newborn’s kidney has an immature concentrating mechanism, so it tends to excrete sodium - it is an obligate sodium loser.
For the same reason, it partially lacks the ability to retain water and glucose
The total body water for a premature neonate is approximately:
(Enter your answer as a percentage)
80 – 90%
The total body water for the premature neonate is 80 – 90%.
Calculate the hourly maintenance rate for a child who weighs 15 kg.
(Enter your answer as a whole number in mL)
50 mL
Unless you are instructed otherwise, you should use the 4:2:1 rule for fluid calculations on the NCE.
Step1: 0-10 kg → Begin with 4 mL/kg/hr
Step 2: 10-20 kg → Add 2 mL/kg/hr to the previous total
Step 3: > 20 kg → Add 1 mL/kg/hr to the previous total
The child in this question weights 15 kg so…
Step 1: 10 kg x 4 mL/kg/hr = 40 mL
Step 2: 5 kg x 2 mL/kg/hr = 10 mL
Answer: 40 mL + 10 mL = 50 mL total
A 2-week-old neonate will be expected to demonstrate all of the following EXCEPT a/an:
faster circulation time.
shorter duration of action for lipid soluble drugs.
increased free fraction of highly protein bound drugs.
larger volume of distribution for water soluble drugs.
Shorter duration of action for lipid soluble drugs
Neonates have a greater percentage of total body water and a lower percentage of fat and muscle mass.
Drugs that require fat for redistribution and termination of effect have a longer duration of action (not shorter).
A high TBW also means that they require higher doses of water soluble drugs to achieve a given plasma concentration.
Since they have lower concentrations of plasma proteins, there will be an increased free fraction of highly protein bound drugs.
The cardiac output in the newborn is 200 mL/kg/min. This accounts for a faster circulation time.
Anesthetic considerations for the administration of neuromuscular blockers in the neonate include:
avoidance of succinylcholine.
a larger dose of succinylcholine.
a longer duration of action of succinylcholine.
a larger dose of succinylcholine and nondepolarizing neuromuscular blockers.
A larger dose of succinylcholine
The combination of an increased ECF and normal sensitivity of succinylcholine necessitates an increased dose of 2 mg/kg. Its duration is similar between neonates and adults (not increased).
The black box warning on succinylcholine warns of hyperkalemia associated with undiagnosed muscular dystrophy in children under eight years old. Considering this, succinylcholine remains a suitable option for rapid sequence intubation, anticipated difficult airway, laryngospasm, or other airway emergencies.
The dose for nondepolarizers is the same for neonates and adults on a per kg basis.
Which lecithin/sphingomyelin ratio suggests fetal lung maturity?
- 5
- 0
- 5
- 0
2.0
An L/S ratio of 2.0 or greater suggests fetal lung maturity.
An L/S ratio less than 2.0 suggests immature fetal lungs and may place the fetus at risk for respiratory distress syndrome.
What is a late finding in the patient with pyloric stenosis?
Metabolic acidosis
Alkaline urine
Hyponatremia
Hyperkalemia
Metabolic acidosis
Pyloric stenosis occurs when hypertrophy of the pyloric muscle creates a mechanical obstruction at the gastric outlet (between the stomach and the duodenum).
Vomiting causes the infant to lose H+ and electrolytes, so he will commonly present with:
Metabolic alkalosis Hyponatremia Hypokalemia Alkaline urine
If vomiting persists, and dehydration is not corrected, impaired tissue perfusion increases lactic acid production (metabolic acidosis).
What is the MOST appropriate gas mixture for the neonate with necrotizing enterocolitis?
30% oxygen + 70% nitrous oxide
50% oxygen + 50% nitrous oxide
50% oxygen + 50% air
100% oxygen
50% oxygen + 50% air
Necrotizing enterocolitis is necrosis of the bowel. The two most important risk factors are prematurity (< 32 weeks) and low birth weight (< 1,500 g).
Since many of these babies experience bowel perforation, they present to the OR for bowel resection. Nitrous oxide is contraindicated. That eliminates two of the answer choices.
Since they’re premature, they’re also at risk of retinopathy of prematurity. For this reason, you’ll want to decrease the FiO2 to maintain the SpO2 between 89 - 94%. This means that 50% oxygen + 50% air is the best gas mixture for this patient.
Select the MOST significant risk factor for retinopathy of prematurity.
Sepsis
Hypoxemia
Intraventricular hemorrhage
Prematurity
Prematurity
Explanation:
Retinopathy of prematurity causes abnormal vascular development in the retina. The immature retinal blood vessels are at risk for vasoconstriction and hemorrhage. Dysfunctional healing creates scars. As the scars retract, they pull on the retina, causing retinal detachment and blindness.
Vasculogenesis occurs 16 - 44 weeks after conception. It’s during this time that the patient is at risk for ROP. Prematurity and hyperoxia are the two most significant risk factors.
Based on experimental animal data, which anesthetic agents are MOST likely to cause apoptosis? (Select 2.)
Midazolam
Dexmedetomidine
Fentanyl
Ketamine
Ketamine
Midazolam
Explanation:
In experimental animal models, drugs that antagonize the NMDA receptor, stimulate GABA, or both may cause apoptosis.
Examples include:
Halogenated anesthetics Nitrous oxide Propofol Ketamine Etomidate Barbiturates Benzodiazepines
Match each shunt with its location within the fetal circulation.
Ductus venosus + Umbilical vein → inferior vena cava
Foramen ovale + Right atrium → left atrium
Ductus arteriosus + Pulmonary artery → proximal descending aorta
The fetal circulation differs from the adult circulation in several ways. In the fetus, gas exchange occurs in the placenta (not the lungs). Also, the circulation is organized in such a way that the blood with the highest oxygen content is preferentially delivered to the heart and brain. This arrangement is dependent on the function of 3 shunts.
Ductus venosus:
Umbilical vein → inferior vena cava
Oxygen rich blood from the placenta bypasses the liver
Foramen ovale:
Right atrium → left atrium
Oxygen rich blood bypasses the lungs and is preferentially delivered to the heart and developing brain
Ductus arteriosus: Pulmonary artery (or RV) → proximal descending aorta Lower oxygen blood bypasses the lungs and is delivered to the lower body
Which conditions increase pulmonary vascular resistance? (Select 3.)
Light anesthesia
Hypercarbia
Anemia
Nitric oxide
Alkalosis
Trendelenburg position
Hypercarbia
Trendelenburg position
Light anesthesia
The balance between PVR and SVR is important in the patient with congenital heart disease, and understanding this concept will help you answer a variety of questions about this patient population.
This question asked you about conditions that increase PVR. Notice that each of the examples below decrease vessel diameter, increase pulmonary blood volume, or both.
Conditions that increase PVR: Hypercarbia Hypoxemia Acidosis Atelectasis Trendelenburg position Hypothermia Vasoconstrictors Light anesthesia Pain
Which congenital defects are MOST likely to cause hypoxemia? (Select 3.)
Ebstein's anomaly Patent ductus arteriosus Tetralogy of Fallot Eisenmenger's syndrome Coarctation of the aorta Ventricular septal defect
Tetralogy of Fallot
Eisenmenger’s syndrome
Ebstein’s anomaly
Shunting occurs when there is an abnormal communication between the pulmonary and systemic circulations.
Cyanotic Shunt (R → L):
A right-to-left shunt allows blood to bypass the pulmonary circulation and enter the systemic circulation. Examples include:
Tetralogy of Fallot
Transposition of the great arteries
Tricuspid valve abnormality (Ebstein’s anomaly)
Truncus arteriosus
Total anomalous pulmonary venous connection
Acyanotic shunt (L → R): A left-to-right shunt causes oxygenated pulmonary venous blood to return directly to the lungs instead of being pumped to the body. Examples include: Ventricular septal defect (most common) Atrial septal defect Patent ductus arteriosus Coarctation of the aorta
During surgical repair of tetralogy of Fallot, the patient’s blood pressure declines by 25% and the SpO2 decreases by 10%. What are the MOST likely explanations for these findings? (Select 2.)
Pulmonary vascular resistance decreased
Systemic vascular resistance decreased
Preload increased
Myocardial contractility increased
SVR decreased
Myocardial contractility increased
Tetralogy of Fallot is characterized by four defects:
Ventricular septal defect
Aorta that overrides the RV and LV
Pulmonic stenosis (obstruction to RV ejection)
RV hypertrophy
Your job is to minimize the R-to-L shunt by satisfying the following goals.
Increase SVR
Decrease PVR
Maintain Contractility and HR
Increase Preload
Failure of the fossa ovalis to close results in what type of atrial septal defect?
Perimembranous
Sinus venosus
Secundum
Primum
Secundum
There are three types of atrial septal defects:
Secundum ASDs occur in the middle of the atrial septum and result when the fossa ovalis fails to close. This type of ASD represents ~ 80% of all ASDs.
Primum ASDs occur in the lower region of the atrial septum, just above the tricuspid valve.
Sinus venosus ASDs are located just below the IVC or less commonly just above the IVC.
The most common type of ventricular septal defect is the perimembranous VSD. It is located in the middle of the ventricular septum, just below the septal leaflet of the tricuspid valve.
A patient is undergoing surgical repair for coarctation of the aorta. Select the BEST site to monitor the arterial blood pressure.
Right arm
Right leg
Left arm
Left leg
Right arm
Coarctation of the aorta occurs when the aorta narrows in the area of the ductus arteriosus.
Since the aorta is narrowed, the LV must generate a higher pressure to overcome the increased aortic resistance. Severe narrowing can limit the amount of blood delivered to the lower half of the body.
Although rare, coarctation may occur proximal to the left subclavian artery, reducing perfusion to the left upper extremity. For this reason, the right upper extremity is the best site to measure blood pressure.
The patient scheduled for a Fontan procedure MOST likely has a diagnosis of:
transposition of the great arteries.
Ebstein’s anomaly.
hypoplastic left heart syndrome.
truncus arteriosus.
Hypoplastic left heart syndrome
All patients with a single ventricle require surgical correction with the Fontan procedure.
Hypoplastic left heart syndrome is the most common single ventricle lesion.
Compared to epiglottitis, which findings are MORE likely to occur with laryngotracheobronchitis? (Select 3.)
Age affected < 2 years Onset between 24 - 72 hours High fever Steeple sign Tripod position More likely to require anesthesia for urgent airway control
Age affected < 2 years
Onset between 24 - 72 hours
Steeple sign
It is essential that you understand the similarities and differences between epiglottitis and croup.
When diluted into 2.5 mL of 0.9% sodium chloride, what is the MOST appropriate dose of racemic epinephrine to administer to the child with postintubation croup?
0.5 mL of a 0.25% solution
0.5 mL of a 2.25% solution
5 mL of a 0.25% solution
5 mL of a 2.25% solution
0.5 mL of a 2.25% solution
Racemic epinephrine and dexamethasone serve as the cornerstone in the treatment of postintubation croup.
Racemic epinephrine = 0.5 mL of 2.25% solution diluted in 2.5 mL of 0.9% NaCl
Dexamethasone = 0.25 - 0.5 mg/kg IV
