Book 5, Case 4-Pedi asthma and hemophilia Flashcards
Which blood disorders have normal PT and elevated PTT:
VWd, Hemophilia A and B, and admin of low dose heparin and lupus anticoagulant
With kids who say they don’t want the surgery-wyd?
include them in the decision making.Why don’t they want the surgery? IF anxiety and fear-consider removing him from pre op area, or discussing pre-op anxiolytic with mom and him. if still refused, have talk with pt, his mom, and surgeon about risks and benefits of delaying procedure until maturity (if non emergent)
Do yo uwanna get factor 8 to 100% before surgery?
yeah-even though levels of 30% can prevent surgical bleeding, I’d like to give to 100% to prevent bleedign.
LMA vs ETT for tonsillectomy:
LMA (if it can seat well and no contraindications), in pts wiht asthma it could be better -ess bronchospasm, laryngospasm and also better protection against blood going into airway. If initally not working-can try to move tongue, lateral insertion, using finger to guide LMA. AND MAKE SURE THIS IS OKAY WITH SURGEON
Children do NOT handle waking up with LMA as well as adults-remove it when?
as soon as they regain conscuiousness if they have other stuff going on (OSHS) or under a deep plane of anesthesia in children who are SPONTANEOUSLY VENTILATING
Pt with Hemophilia A comes back with bleeding, but BP is relatively stable-wyd?
provide 100% o2
order hemoglobin
order FActor 8, coag profile-esp PTT, type and cross, volume and blood replacement as indicated
short acting beta agonist
If pt got steroids, then (for asthma a while ago)-low threshold for what?
low threshold for steroids
KIM that if pt has hypotension following induction…
it could be just the fact that they’re under GA without stimulation. obvioulsy it could be other things.
Explain the whole HPA thing:
chronic treatment with exogenous steroids, can lead to suppression of the
hypothalamic-pituitary-adrenal (HP A) axis, resulting in adrenal atrophy and an inability to
produce adequate cortisol under the physiologic stresses experienced during the perioperative
period.
Why are tonsillectomies associated with more N/V?
because blood can get in stomach.
Does pt with hemophilia A rquire additional doses fo factor 8 post op?
yes for 2 weeks
factor 8 1/2 life 6 hrs
