Care of Pediatrics Flashcards
What makes pediatric patients different?
!Laryngospasm is fairly common problem
What is the age classification for neonates?
0-28d of life
44 weeks post conceptual age
HR 90-160 (asleep)
HR 100-204 (awake)
RR 30 - 53
SBP 67- 84
DBP 35 - 53
What is the age classification for infants?
1-12 months
HR 90-160 (asleep)
HR 100-190 (awake)
RR 30 - 53
SBP 72 -104
DBP 37 - 56
What is the age classification for toddler?
1-3 years
HR 80-120 (asleep)
HR 98-140 (awake)
RR 22 - 37
SBP 86 -106
DBP 42 - 63
What is the age classification for pre-schooler?
3-5 years
HR 65-100 (asleep)
HR 80-120 (awake)
RR 20 - 28
SBP 89 -112
DBP 46 - 72
What is the age classification for school age?
6-12 years
HR 58- 90 (asleep)
HR 75-118 (awake)
RR 18 - 25
SBP 97 -120
DBP 57 - 80
What is the age classification for adolescent?
13-18 years
HR 50- 90 (asleep)
HR 60- 100 (awake)
RR 12 - 20
SBP110-131
DBP 64 - 83
What is the pre-operative NPO guidelines for pediatrics?
Clear liquid - 2 hours
!Breast milk - 4 hours
Infant formula - 6 hours
Non-human milk - 6 hours
Light meal - 6 hours
At what age is separation anxiety is highest among pediatric patients?
8 months - 2 years
Separation anxiety is highest
Most difficult for mask induction
Pre-medication/ Pre-induction useful
At what age is fear of loss of control is highest among pediatric patients?
7-11 years (fear of loss of control)
Generally calm with mask induction1
Fearful of needles
When is CPR initiated for bradycardic infants?
!HR < 60 for infants (birth to 1 year)
Where to check pulse for < 2 years old.
Apical pulse
What are the risk factors for emergence delirium among pediatric patients?
Sevoflurane/ Desflurane anesthesia
Pain
ENT surgery
!Male
Pre-op anxiety
Pre-existing behavior
When to use FLACC behavioral pain scale on pediatric patients?
0-7 years old
FACES can be used as early as 3 years old
What pre medication is commonly used in pediatric patients?
Midazolam (Versed)
What is commonly used dosage of midazolam for pediatric patient?
PO 0.25-1mg/kg (max 20mg)
20-30 minute onset
IV 0.025-0.21 mg/kg
What is the common side effect of midazolam to pediatric patients?
paradoxical excitation
When is ketamine used for pediatric patients?
pediatric patients who have behavioral d/o or very distress/ed uncooperative
What is the side effect of ketamine in pediatric patients?
hallucinations/ dysphoria
PONV
DO NOT USE if increased ICP
What is the dosage of ketamine for pediatric patients?
PO 5-10mg/kg
IV 1mg/kg
How to treat laryngospasm for pediatric patients?
Administered 100% humidified O2
!Apply continuous positive pressure by mask
Suction secretions
Reintubate if severe
What is the general rule for ETT size for pediatric patients?
!Uncuffed ETT must be used until 8 years old to allow slight air leak to be present
What is the dose of zofran for pediatric patients?
0.15mg/kg
Pediatric pain management
Morphine is gold standard for opioids
PCA as young as 5 years old based on manual dexterity and ability to understand the concept
Erikson’s Stages of Development Theories
Infancy (0-1yr) - Basic trust vs. mistrust
Toddler (2-3yr) - Autonomy vs. shame/doubt
Preschool (3-6yr) - Initiative vs. guilt
School age (6-12yr) - Industry vs. inferiority
Adolescense (12-20yr) - Identify vs. role diffusion
Post procedure, a child experienced laryngeal edema. Symptoms subsided after treatment. The parents are instructed to expect:
- oxygen therapy at home
- discharge after 1 hour of observation
- minimal wheezing upon discharge
- monitoring in PACU for 2-4 hours
monitoring in PACU for 2-4 hours
