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Person Peds > Berstein #3 > Flashcards

Berstein #3 Flashcards

1
Q

What is Congenital diaphragmatic Hernia?

A
  • Gut herniates into thorax
  • Left side most common
  • 50% mortality
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2
Q

Congenital Diaphragmatic Hernia presentation?

A
  • Hypoxia
  • Scaphoid abd
  • Pulm HTN
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3
Q

What causes death in Congenital Diaphragmatic Hernia?

A

respiratory insuffiency

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4
Q

Congenital Diaphragmatic Hernia treatment.

A
  • Sedation
  • Paralysis
  • Moderate hyperventilation
  • ECMO
  • Nitric oxide
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5
Q

Congenital Diaphragmatic Hernia anesthesia concerns.

A
  • ↓ gastric distension
  • Low O2 delivery
  • Pressure limited vent
  • R pneumothorax
  • Awake intubation
  • No nitrous oxide
  • Peak pressure <30
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6
Q

What would cause peak pressure to rise in Congenital Diaphragmatic Hernia?

A

Right side pneumpthorax

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7
Q

Why no nitrous in Congenital Diaphragmatic Hernia

A

Bowel distension = more hypoxia

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8
Q

most common Tracheoesophogeal Fistula?

A
  • 3B
  • ends in blind pouch
  • Lower esophagus connects to trachea
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9
Q

Signs of Tracheoesophogeal Fistula.

A
  • Gastric distension w/ respiration

- Feeding leads to choking/cough/cyanosis

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10
Q

anesthesia concerns with Tracheoesophogeal Fistula

A
  • Copious secretions
  • No positive pressure ventilation
  • awake intubation
  • Dehydrated
  • do not extend neck post repair
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11
Q

complications Tracheoesophogeal Fistula

A
  • Pneumonia
  • Atelectasis
  • SubQ emphysema
  • RLN injury
  • esophageal stricture
  • Anastomotic leak
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12
Q

Tracheoesophogeal Fistula principle cause of death

A
  • Pulm complications
  • Associated anomalies
  • Anastomotic leak
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13
Q

In a patient with CDH, what should the peak inspiratory pressure be (cmH20):

A

30

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14
Q

Which is not a manifestation of CDH

A

Lab tests

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15
Q

what is Hypoplastic Left Heart Syndrome

A

Left side of hear fails to develop fully

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16
Q

3 causes of Hypoplastic Left Heart Syndrome

A
  • Mitral stenosis/atresia
  • Aortic stenosis/atresia
  • Hypoplastic aortic arch
  • all duct dependent
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17
Q

What is the goal pf surgery for Hypoplastic Left Heart Syndrome?

A
  • Single ventricle circulation

- Pulm blood flow is passive from vena cava

18
Q

What is done during norwood stage 1

A
  • Neonatal period
  • Aortic arch arise from pulm trunk
  • Pulm valve become aortic valve
  • BT shunt
19
Q

What is a BT shunt?

A

Shunt from subclavian to pulmonary artery

20
Q

What is done during norwood stage 2

A
  • BT shunt disconnected

- Glenn shunt created

21
Q

What is a glenn shunt

A

SVC to pulmonary artery

22
Q

What happens in norwood stage 3 (fontan)?

A

-Both SVC and IVC are connected to pulmonary artery

23
Q

How to increase PVR?

A
  • PEEP
  • High airway pressure
  • Atelectasis
  • Low FiO2
  • acidosis
  • ↑ HCT
  • sympathetic stimulation
  • Surgery
  • Vasoconstrictors
24
Q

How to decrease PVR

A
  • No peep
  • low airway pressure
  • Lung expansion to FRC
  • ↑ FiO2
  • Alkalosis
  • ↓ HCT
  • Blunt stress response
  • Nitric oxide
  • Vasodilators
25
Q

Normal sat w/ BT shunt

A

75%

26
Q

Normal Sat w/ Glenn shhunt

A

85%

27
Q

Normal sat w/ Fontan

A

95%

28
Q

Single ventricle patients have a blunted HRr response to _______.

A

Exercise

29
Q

Why do single vessel patient need normal rhythm?

A

-They will loose ventricle filling

30
Q

In single ventricle patients, CO depends on what?

A

Adequate preload and low PVR

31
Q

What is an arterial switch?

A
  • Arterial trunk transected above semi lunar valve
  • Relocated to correct ventricle
  • Coronary artery re-implanted into aortic root
32
Q

what isTruncus Arteriosus Repair

A
  • Closure of VSD w/ homograft

- Abolishes shunting

33
Q

A 12 lead EKG of a newborn reveals upright T waves in all chest leads. Is this normal?

A

Yes. The t waves are upright in all chest leads at birth.

34
Q

Failure of the V1-V4 T waves to invert by one week of age can indicate whay?

A

Right ventricle hypertrophy

35
Q

How does the QRS axis appear at birth?

A

Due to the predominance of the RV during intrauterine development, the QRS axis is right sided at birth. It shifts leftward by about one month of age

36
Q

How does the normal CO of an infant compare to that of an adult?

A

full term infant has a CO that is about 2-3 times that of an adult

37
Q

What is the normal HR of a 1-3 yr old?

A

70-110

38
Q

What is the normal HR of a 3-6 yr old?

A

65-110

39
Q

What does millirone do?

A
  • Increase inotropy and
  • lusitrophy (diastolic relaxation)
  • Decreases PVR
40
Q

When is millirone used?

A

When peds come off bypass

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