Chapter 10 - Paediatrics Flashcards

1
Q

Several anatomical features of children affect airway assessment and management - name them.

A

Tongue and tonsils relatively larger

Funnel shaped larynx - accumulation of secretion in retropharyngeal area

Larynx and vocal cords are more cephalad and anterior in the neck

Shorter trachea - 5cm in infants and 7cm by 18mo

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2
Q

What is the correct formula to calculate the ETT depth (in cm) in pediatrics?

A

The appropriate ETT x 3

Example: size 4.0 x 3 = 12

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3
Q

In infants an uncuffed ETT is used as the cricoid ring forms a natural seal.

In infants and a children a cuffed ETT may be used.

What is the ideal cuff pressure measurement?

A

< 30 mmHg is considered safe

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4
Q

Describe a simple technique to gauge the ETT size needed for pediatric patients

A

Approximate the diameter of the child’s external nares OR

Use the diameter of the tip of the smallest finger

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5
Q

What are the dosages for the following drugs used in pediatric RSI / Drug Assisted Intubation

    1. Atropine
    1. Etomidate
    1. Midazolam
    1. Succinylcholine
    1. Rocuronium
    1. Vecuronium
A
    1. 0.1 - 0.5mg
    1. Hypovoleamia 0.1 mg.kg and 0.3mg.kg
    1. 0.1 mg.kg for both
    1. 2mg.kg <10kg and 1mg.kg >10kg
    1. 0.6mg.kg
    1. 0.1mg.kg
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6
Q

Can’t intubate can’t ventilate - what next?

A

Rescue airway device -

LMA
Intubating LMA
Surgical cricthyroidotomy (needle-jet insufflation)

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7
Q

List the common causes of deterioration in an intubated patient.

A

“Don’t be DOPE”

D- Dislodgement due to short trachea

O- Obstruction - if secretions then suction, if tube kinks then replace ETT

P- Pneumothorax - can develop Tension pneumothorax related to positive pressure ventilation - decompress

E- Equipment failure - ensure that your equipment is well maintained and properly functioning - have backup equipment

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8
Q

In pediatrics, what is the normal

    1. Breathe rate?
    1. Tidal volume
A

1.1.
Infants - 30-40

Older children - 15-20

1.2.

Infants and children 4-6 ml.kg
Occasionally higher tidal volumes of 6-8 ml.kg (as high as 10) during assisted ventilation

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9
Q

In cases of tension pneumothorax, how would you perform a needle decompression?

A

14-18 gauge over the needle catheter is inserted just above the 3rd rib in the midclavicular line

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10
Q

In children, up to a 30% decrease in circulating blood is needed for a drop in SBP.

Which signs are early features of hypovoleamia?

A

Tachycardia
Poor skin perfusion

Weakening of peripheral pulses
Narowing of pulse pressures to < 20mmHg
Skin mottling (which substitutes for clammy skin in infants and young children) 
Cool extremities
Decreased LOC
Dulled response to pain
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11
Q

What is the formula to calculate the

  1. 1 mean normal SBP
    1. Lower limit normal SBP
    1. Diastolic BP
A
    1. 90mmHg + twice child’s age in years
    1. 70mmHg + twice child’s age in years
    1. 2/3 SBP
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12
Q

Name the methods used to estimate a child’s weight

A

1 - ask the caregiver

2 - length based resuscitation tape

3 - weight formula - (2 x age in years) + 10

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13
Q

What are the values for the estimated blood volume for

    1. Infant 0-12 months
    1. Child 1-3 years
    1. Child older than 3 years
A
    1. 80ml.kg
    1. 75ml.kg
    1. 70ml.kg
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14
Q

If peripheral venous access is unsuccessful after 2 attempts - what would be the next step?

A

Intraosseous infusion via bone-marrow needle

18G in infants
15G in young children OR

Insertion of femoral venous line of appropriate size using Seldinger technique

If this fails THEN

Venous cut down (last resort)

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15
Q

What is the lethal triad in trauma?

A

Hypothermia
Acidosis
Trauma-induced coagulopathy

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16
Q

What is the initial fluid resuscitation strategy recommendations for injured children?

A

Initial fluid bolus of 20ml.kg with crystalloid solution followed by 1-2 further bolus depending on the child’s physiological response

If evidence of ongoing bleeding after 2-3rd bolus THEN

10ml.kg of packed red blood cells may be given

17
Q

What is the massive transfusion protocol for injured children?

A

Intial 10-20ml.kg bolus with isotonic crystalloid fluids FOLLOWED BY

10-20ml.kg packed red blood cells PLUS

10-20ml.kg FFPs and platelets

18
Q

Indications for diagnostic peritoneal lavage (DPL)

NOTE - only the surgeon who will ultimate treat the child should perform a DPL

A

Children with suspected intra-abdominal bleeding

Haemodynamic abnormalities AND
Cannot safely be transported to CT scan
CT scan and FAST not readily available AND
Presence of blood will lead to immediate operative intervention

19
Q

Discuss the pitfalls of DPL

A

Limited to diagnosing injuries of intra-abdominal viscera only
Retroperitoneal organs cannot be assessed
Procedure interferes with subsequent abdominal examinations and imaging

20
Q

Basilar odontoid synchondrosis (where the odontoid process meets C2 VB) appears as a radiolucent area at the base of the dense on X-ray in children less than 5 years.

Apical odontoid epiphysis appear as separations on the odontoid X-ray - between which ages?

A

5 and 11 years