Chapter 10 - Paediatrics Flashcards
Several anatomical features of children affect airway assessment and management - name them.
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
What is the correct formula to calculate the ETT depth (in cm) in pediatrics?
The appropriate ETT x 3
Example: size 4.0 x 3 = 12
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?
< 30 mmHg is considered safe
Describe a simple technique to gauge the ETT size needed for pediatric patients
Approximate the diameter of the child’s external nares OR
Use the diameter of the tip of the smallest finger
What are the dosages for the following drugs used in pediatric RSI / Drug Assisted Intubation
- Atropine
- Etomidate
- Midazolam
- Succinylcholine
- Rocuronium
- Vecuronium
- 0.1 - 0.5mg
- Hypovoleamia 0.1 mg.kg and 0.3mg.kg
- 0.1 mg.kg for both
- 2mg.kg <10kg and 1mg.kg >10kg
- 0.6mg.kg
- 0.1mg.kg
Can’t intubate can’t ventilate - what next?
Rescue airway device -
LMA
Intubating LMA
Surgical cricthyroidotomy (needle-jet insufflation)
List the common causes of deterioration in an intubated patient.
“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
In pediatrics, what is the normal
- Breathe rate?
- Tidal volume
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
In cases of tension pneumothorax, how would you perform a needle decompression?
14-18 gauge over the needle catheter is inserted just above the 3rd rib in the midclavicular line
In children, up to a 30% decrease in circulating blood is needed for a drop in SBP.
Which signs are early features of hypovoleamia?
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
What is the formula to calculate the
- 1 mean normal SBP
- Lower limit normal SBP
- Diastolic BP
- 90mmHg + twice child’s age in years
- 70mmHg + twice child’s age in years
- 2/3 SBP
Name the methods used to estimate a child’s weight
1 - ask the caregiver
2 - length based resuscitation tape
3 - weight formula - (2 x age in years) + 10
What are the values for the estimated blood volume for
- Infant 0-12 months
- Child 1-3 years
- Child older than 3 years
- 80ml.kg
- 75ml.kg
- 70ml.kg
If peripheral venous access is unsuccessful after 2 attempts - what would be the next step?
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)
What is the lethal triad in trauma?
Hypothermia
Acidosis
Trauma-induced coagulopathy