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principles 3 > exam 4 > Flashcards

exam 4 Flashcards

1
Q

what 2 age groups do not need sedation

A

< 6 months

6-12 years (may worsen overall experience)

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2
Q

goal

pH > ___
volume < ____

A

pH > 2.5
volume < 0.4 ml/kg

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3
Q

true or false

allergic rhinitis has NO fever

A

true

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4
Q

Hct > ___

A

25

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5
Q

exceptions for Hct being LOWER

A

chronic renal failure
2-4 months old

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6
Q

anemia shifts to the

A

R

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7
Q

true or false

Do NOT transfuse preop to get Hct up

A

true

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8
Q

asymptomatic fever of ___-___ OKAY to do fever!

A

0.5-1

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9
Q

sickle cell tranfuse to Hgb of

A

10

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10
Q

asthma

extubate ______**

A

DEEP

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11
Q

asthma

PaCO2 > ____ = increased risk for postop respiratory FAILURE

A

> 45

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12
Q

Chronic lung disease related to prolonged mechanical ventilation/barotrauma/O2 toxicity

A

bronchopulmonary dysplasia

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13
Q

bronchopulmonary dysplasia

use:
_______ ETT
______capnia

A

SMALLER ETT
HYPERcapnia/hypoventilation

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14
Q

what is the ONLY certain way to rule out structural defect

A

ECHO

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15
Q

type 1 diabetes

___% glucose
____ of usual insulin dose

or

__________ infusion of glucose + insulin

A

5% glucose
1/2 usual insulin dose

continuous infusion of glucose + insulin

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16
Q

hyperalimentation

decrease rate by ___ to ___

A

decrease
1/3 to 1/2

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17
Q

true or false

H2 blockers and steroids do NOT prevent anaphylaxis

A

true

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18
Q

EMLA cream is what 2 LAs

A

lidocaine
prilocaine

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19
Q

atropine

____ in infants < 6 months

A

IM

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20
Q

Maintain high sevo with SPONTANEOUS ventilation, until ___ access obtained

A

IV

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21
Q

Treat ____________ STAT

A

bradycardia

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22
Q

What are children dependent on

A

HR

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23
Q

airway obstruction

slightly _______ APL valve to generate 5-10 cm PEEP

A

CLOSE

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24
Q

true or false

do NOT take over ventilation/mechanically ventilate BEFORE IV access is obtained

A

true

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25
Q

single breath induction
requires

_____ flow
__% sevo

A

HIGH flow
8% sevo

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26
Q

IV induction

____% nitrous, ____% oxygen

A

50%

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27
Q

true or false

RSI
NO positive pressure ventilation until ETT placement is confirmed

A

true

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28
Q

modified RSI

USE positive pressure (< ___)

A

< 15

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29
Q

true or false

laryngospasm:
can occur anytime,
have NO cause
any technique
any patient

A

true

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30
Q

biggest cause of laryngospasm

A

stage 2 (secretions/stimulation)

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31
Q

when does bronchospasm occur

A

emergence, before extubation

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32
Q

best airway maneuver for upper airway obstruction (tongue)

A

jaw thrust

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33
Q

best Prophylaxis

A

IV fluids +
5-HT3 antagonist + dexamethasone

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34
Q

best Rescue

A

5-HT3 antagonist
Phenergan
Non-opioid analgesics

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35
Q

HYPOtension is UNCOMMON in peds

2 exceptions

A

CHD
hypovolemia

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36
Q

hypothermia
< ___

A

< 36

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37
Q

emergence delirium

< ___ years old
___-___ minutes

A

< 6 years
5-15 min

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38
Q

ETT cuff pressure

soft max
hard max

A

soft = 20
hard = 25

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39
Q

laryngeal edema (pressure) leads to

A

subglottic stenosis

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40
Q

treatment for laryngeal edema/subglottic stenosis

A

laryngeal tracheal reconstruction (LTR) with cartilage grafting

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41
Q

low birth weight

A

< 2500

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42
Q

VERY low birth weight

A

< 1500

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43
Q

EXTREMELY low birth weight

A

< 1000

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44
Q

when is surfactant production complete

A

36 weeks

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45
Q

Incidence of apnea significantly decreases at ___ weeks post-conceptual age

A

55

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46
Q

types of apnea

A

central
obstructive
mixed

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47
Q

3 factors for apnea

A

post-conceptual age*
Hct
surgical procedure

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48
Q

patent ductus arteriosus (PDA) =

A

pulmonary HTN + CHF

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49
Q

Pain receptors begin developing at ___ weeks’ gestation

A

19

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50
Q

when does pain perception and memory begin?

A

regardless of gestational age

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51
Q

Premie method of heat production:

A

NON-shivering thermogenesis

dependent on brown fat

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52
Q

peds

__________ renal function
_____natremia
____________

A

DECREASED renal function
HYPOnatremia
thrombocytopenia

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53
Q

PREductal **

A

R hand

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54
Q

POSTductal **

A

L or R foot preferably

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55
Q

Choanal Atresia + Stenosis

“CHARGE” syndrome

biggest issue*

A

heart disease

(nose issue)

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56
Q

biggest thing to remember with laryngeal webs*

A

NEVER proceed without ENT available for tracheostomy

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57
Q

subglottic stenosis

_________ ETT needed**
__________ in airway resistance

A

SMALLER ETT
INCREASE in airway resistance

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58
Q

Tracheoesophageal Fistula

frequently with __________ syndrome

A

VACTERL

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59
Q

Tracheoesophageal Fistula (TEF) has risk of**

A

Congenital heart disease*

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60
Q

Tracheoesophageal Fistula

most common =

A

blind esophageal pouch

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61
Q

Tracheoesophageal Fistula

correct ETT is crucial:
BELOW _______ and ABOVE ________

A

below fistula

above carina

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62
Q

Tracheoesophageal Fistula

confirmation of ETT with

A

fiberoptic scope

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63
Q

Congenital Diaphragmatic Hernia (CDH)

inability to oxygenate with mediastinal shift!
huge _____________**

A

EMERGENCY**

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64
Q

congenital diaphragmatic hernia

TREATMENT**

A

pulmonary vasodilators (nitric)

ECMO

oscillators, HFJV

EXIT procedure

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65
Q

congenital diaphragmatic hernia

heart is shifted to the ___

require high PIPS, risk = ____*

A

heart = R

risk of PTX

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66
Q

true or false

intestinal obstruction
has other anomalies!

A

true

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67
Q

intestinal obstruction

needs:

A

RSI

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68
Q

intestinal obstruction

issues

A

Abdominal distension with 3rd spacing, vomiting, electrolyte imbalance*

Sepsis*

anemia

other anomalies

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69
Q

true or false

pyloric stenosis

MEDICAL emergency
NOT a SURGICAL emergency!

A

true

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70
Q

3 symptoms of pyloric stenosis

A

HYPOkalemic
HYPOchloremic
metabolic ALKALOSIS

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71
Q

true or false

imperforate anus

should have CV evaluation with ECHO preop*

A

true

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72
Q

Very sick patient*

A

necrotizing enterocolitis

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73
Q

5 symptoms of necrotizing enterocolitis

A

ACIDOSIS
coag dysfunction
HYPOtensive
ANEMIA
3rd spacing, fluid loss

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74
Q

GI organs outside abdominal wall

A

omphalocele
gastroschisis

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75
Q

which is the worst*

A

omphalocele
(CV, renal issues)

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76
Q

what drug is omphalocele treated with preop

A

silo

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77
Q

Incomplete migration or malrotation of intestines from yolk sac into abdomen

Emergent if strangulation is suspected

A

volvulus

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78
Q

CONTRAindication with all intestinal obstructions

A

nitrous

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79
Q

3 symptoms with volvulus

A

HYPOtensive
HYPOvolemic
electrolyte imbalance

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80
Q

Most common neonatal colonic obstruction

A

hirschsprung disease

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81
Q

hirschsprung disease

absence of ____

A

PNS

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82
Q

what is a CONTRAindication for hirschsprung**

A

NMBs (due to nerve monitoring)

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83
Q

PDA ligation

with L to R shunting,________ can occur

A

CHF + respiratory failure

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84
Q

With persistent pulmonary HTN of the newborn (PPHN),

______________________
can occur

A

R to L shunting (cyanotic)

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85
Q

PDA ligation

consider what kind of monitoring

A

pre-ductal
post-ductal

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86
Q

5 common neonatal procedures

A

shunts
CVLs
trachs
fundoplication
gastrostomy tubes

LASER
VP shunts, EVDs
bronchoscopies/esohphagoscopies

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87
Q

L to R ***

A

INCREASING pulm flow

NON-cyanotic

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88
Q

R to L ***

A

DECREASING pulm flow

cyanotic

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89
Q

Mixed

A

cyanotic

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90
Q

3 types of L to R
CHD

A

atrial septal defect (ASD)
ventricular septal defect (VSD)
patent ductus arteriosis (PDA)

91
Q

1 type of R to L
CHD

A

TOF

92
Q

2 types of Mixed
CHD

A

transposition of great arteries (TGA)

hypoplastic L heart syndrome (HLHS)

93
Q

2 types of obstructive
CHD

A

aortic stenosis (AS)

coarctation of aorta (CoA)

94
Q

what is the type of

atrial septal defect

A

patent foramen ovale

95
Q

biggest precaution
for atrial septal defect

A

bubble precautions

96
Q

Most common CHD in children

A

VSD

97
Q

what type of VSD is most common

A

perimembranous

98
Q

which is WORST type of VSD

A

NON-restrictive (high flow, more problems)

99
Q

VSD

severity and management dependent on
(4)

A

defect SIZE
degree of SHUNT
pulm VR
SVR

100
Q

decreased pulmVR = ____________ L to R flow + pulmonary steal

A

INCREASED

101
Q

where is the PDA

A

pulmonary artery + aorta

102
Q

after birth, pulmVR ___________**

A

decreases

103
Q

treatment for PDA

A

ligation with L thoracotomy

VATS

104
Q

measures arterial O2 AFTER leaving the heart
but BEFORE it reaches the ductus

A

pre-ductal

105
Q

measures arterial O2 AFTER leaving the heart
and AFTER it passes the ductus

A

post-ductal

106
Q

PRE-Ductal SaO2 > __% ABOVE POST-ductal =
R to L ductal shunting**

A

> 3%

107
Q

4 features of TOF

A

RV outflow obstruction
(lung issue)

RV hypertrophy

overriding aorta

VSD

108
Q

cyanosis (R to L) for TOF

dependent on (2)

A

RVOTO (RV obstruction)

SVR

109
Q

2 drugs for TET spell

A

phenylephrine (1 mcg/kg)

beta blocker (propranolol)

110
Q

anesthetic implications for TOF

A

keep pulmVR LOW
keep SVR NORMAL
INCREASE preload
AVOID tachy

111
Q

Aorta rises from the R ventricle; pulmonary artery arises from the L ventricle

A

Transposition of the Great Arteries (TGA)

112
Q

fetal circulation is

A

parallel

113
Q

what is needed with transposition so a patient does not die

A

PDA
VSD

114
Q

if not having a PDA or VSD, how is transposition kept open (2)

A

prostaglandins (PGE1)

surgical balloon septostomy

115
Q

5 features of
hypoplastic L heart syndrome

A

1) hypoplastic/small LV

2) mitral stenosis/atresia

3) aortic stenosis/atresia

4) hypoplastic/small aorta

5) ductal-dependent circulation (PDA)

116
Q

treatment for hypoplastic L heart syndrome

A

prostaglandins

RV becomes systemic pump
(3 stages: norwood)

transplant

117
Q

4 anesthetic implications for

hypoplastic L heart syndrome

A

MAINTAIN CO
keep sao2 75-85%
LOW Vt
LOW PEEP

118
Q

aortic stenosis

the HIGHER the gradient, the ________ it is to get blood across

A

HARDER/more risky

119
Q

treatment for aortic stenosis

A

emergent valvuloplasty

120
Q

biggest implication for aortic stenosis

A

AVOID tachycardia

121
Q

2 types of
coarctation of aorta (CoA)

A

1) neonatal
2) > 1 year old

122
Q

better diagnosis for CoA

A

> 1 year old

123
Q

cardiopulm bypass

CONTRAindicatated fluids

A

dextrose
lactate

124
Q

big thing to pay attention to with CHD patients

A

exercise tolerance

125
Q

chronic hypoxia can lead to _______ Hct

A

higher (polycythemia)

increased viscosity, decreased organ perfusion

126
Q

when do TET spells commonly occur

A

induction! (stress)

or emergence

127
Q

avoid 3 things with pulm HTN

A

acidosis
HYPERcarbia
HYPOthermia

128
Q

Paradoxical Air Embolus

occurs with what types of shunt

A

R to L
increased R sided pressure

129
Q

For atrial arrhythmias, anticoags should be stopped ___-___ weeks preop

A

1-2

130
Q

Anticoags should be restarted ___-___ days postop

A

1-3

131
Q

Irreversible PULM VASCULAR disease, shunt reversal with severe hypoxemia

A

eisenmenger syndrome

132
Q

what do eisenmenger syndrome die from

A

sudden ventricular dysrhythmias

133
Q

post-transplant patients

USE
______-acting agents

A

DIRECT-acting

134
Q

post-transplant patients

↑ HR due to _______________

A

↑ HR due to loss of PNS tone*

135
Q

Bi-Atrial Repair

Dissect a portion of the RA from the donor heart, end up with a portion of 2 RAs, the SA node is now present in both, so you get double ___ waves

A

P

136
Q

drug of choice for endocarditis

A

penicillin

cephalosporin, clindamycin

137
Q

Urethra opens on the underside of the penis

A

Epispadias (top)
Hypospadias (bottom, more common)
Chordee

138
Q

Undescended testes “pulled down” into scrotum

A

Orchiopexy

139
Q

GU procedures

type of anesthetic

A

GA

sometimes with regional

140
Q

______________ risk during foreskin, hernia and testes retraction

A

Laryngospasm

141
Q

For reflux at the ureter/bladder junction

A

Ureteral reimplantation

142
Q

always unilateral
do NOT use caudal or regional

A

pyeloplasty

143
Q

2 symptoms of chronic kidney disease

A

anemia
HTN

144
Q

positioning for nephrectomy

A

lateral/prone

145
Q

Highly associated with CV defects*

A

Bladder and Cloacal Exstrophy

failure of abdominal wall to close over anterior bladder wall

146
Q

true or false

Ears, kidneys, hearts are developing at the same time embryologically

A

true

147
Q

which type of scoliosis has the highest risk

A

neuromuscular (duchenne)

148
Q

Vital capacity begins to decrease at ___°, becomes severe at ___°

A

60
Severe at 100

149
Q

neuromuscular has

prolonged ____
decreasing factor ___

A

prolonged PTT

decreasing factor VII

150
Q

Long, bloody, high risk

A

Posterior Spinal Fusions

151
Q

true or false

spinal surgery:

PRBCs MUST be available
and
Soft bite block*

A

true

152
Q

Periop vision loss is usually due to

A

ischemic optic neuropathy

153
Q

biggest risk factors for periop vision loss (2)

A

> 6 hrs
high blood loss

154
Q

___° C drop in core temp = 3x increased risk of wound infection

A

2 C

155
Q

Controlled hypotension (MAP of ___–___)

A

50-65

156
Q

true or false

controlled hypotension
is CONTROVERSIAL, needs ALINE

A

true

157
Q

dilutional thrombocytopenia

A

PLTs

158
Q

replace factors

A

FFP

159
Q

when are motor pathways most vulnerable to ischemia

A

during hardware insertion

160
Q

what has replaced the “wake-up test”

A

SSEP and MEP

161
Q

anesthetic agents

_________ amplitude
_________ latency

A

DECREASE amplitude
INCREASE latency

162
Q

best type of anesthetic for spinal surgery

A

propofol + opioid (remi or suf)

163
Q

2 CONTRAindications in spinal surgery

A

NMBs
N2O

164
Q

child

large ratio for:

A

surface area : volume

165
Q

common

hypo and hyper:

A

natremia and kalemia

166
Q

Use volumetric chambers, micro-drips and/or pumps for children < ___ years old

A

< 10

167
Q
  • Headache
  • Nausea
  • Weakness
  • Confusion
  • Irritability
  • Seizures
  • Respiratory arrest
  • Irreversible neurologic injury
A

HYPOnatremia

168
Q

HYPOnatremia

correction:
asymptomatic =
acute =

A

asymptomatic = SLOW
acute = RAPID

169
Q
  • Irritability
  • Coma
  • Seizures
A

HYPERnatremia

170
Q

treatment for HYPERnatremia

A

colloid or NS

SLOW correction

171
Q
  • Muscle weakness
  • Prolonged QT**
  • Dampened T waves
  • U waves

Acute
* Vomiting
* Diarrhea

A

HYPOkalemia

172
Q

treatment for HYPOkalemia

A

SLOW correction
oral if available

173
Q
  • Peaked T waves
  • PR lengthening
  • QRS widening
  • Eventually, sinusoidal

Acute
* Renal insufficiency
* Massive tissue trauma
* Acidosis
* Sch with myopathies, burns, motor neuron disease, sepsis, massive transfusion, MH

A

HYPERkalemia

174
Q

treatment for HYPERkalemia

A

IV calcium
bicarb
glucose/insulin

175
Q

ratio for blood products or colloids

A

1:1

176
Q

ratio for isotonic crystalloid

A

1: 1.5-3

177
Q

best type of crystalloid for blood loss*

A

Plasmalyte or Normosol is preferred

178
Q

what can NS cause

A

“Hyperchloremic Acidosis”

excess chloride

179
Q

“Old” PRBCs have ______________ risk

A

hyperkalemia

180
Q

2 increased risks for PRBCs hyperkalemia

A

irradiation
increased shelf time

181
Q

causes of hyperkalemia

A

HYPOthermia**
HYPOcalcemia

182
Q

true or false

better to use PIV
rather than CVL

A

true

183
Q

Massive transfusion leads to _____calcemia

A

hypo

184
Q
  • Widened QRS
  • Prolonged QT
  • Peaked T waves
A

Hypocalcemia and/or Citrate Toxicity

185
Q

best type of albumin

A

5%

186
Q

massive blood transfusion

> ____ml/kg in 4 hrs

replacement of 1 or more BVs

A

> 30

187
Q

best blood type for emergent

A

O -

O+ for males

188
Q

coagulopathy from massive blood transfusion

3 causes

A

dilution**
fibrinolysis
DIC

189
Q

Recommendation:
Give FFP after 1 BV loss, then __ FFP: __PRBCs

A

1 FFP: 2 PRBCs

190
Q

fluid deficit

______________ x ____ NPO

A

maintenance rate x hrs NPO

191
Q

preterm

A

100 ml/kg

192
Q

full term - 1 year

A

90 ml/kg

193
Q

1 - 3 years

A

80 ml/kg

194
Q

toddler - 8 years

A

75 ml/kg

195
Q

> 8 years

A

70 ml/kg

196
Q

MABL = ____ x (________ -_______)
/ __________

A

EBV x (starting - trigger)
/
starting

197
Q

***Do not exceed 20 ml/kg/hr

Unless:

A

replacing blood loss
or
actively bleeding

198
Q

major indication for spinal

A

infants

199
Q

what drug doubles DURATION for spinal

A

clonidine

200
Q

conus medullaris in infant is more _________

A

CAUDAL

201
Q

conus medullaris reaches adult level at age ___

A

1

202
Q

puncture should be at
L__-__ or L__-S__

A

L4-L5
L5-S1

203
Q

sacrum is _________ and ______

A

narrower

flatter

204
Q

lagmenta flava is _____ dense

A

LESS

205
Q

CSF turnover rate is _______

A

greater

shorter duration

206
Q

cm between skin and SA space

A

< 1.5

207
Q

SEDATION due to DECREASED sensory input to RAS from periphery
(can be advantage or disadvantage)

A

deafferentation

(sometimes, its good to have a little pain)

208
Q

CONTRAindication for SAB

A

Ketamine, more apnea than GA!

209
Q

true or false

NO leg raises to avoid high spinal

A

true

210
Q

causes of LAST (2)

A

bupivacaine
amide

211
Q

best drug for epidural

A

2-chloroprocaine

212
Q

caudal

palpate

A

posterior superior iliac spines/sacral cornu

213
Q

___ angle

A

45

214
Q

angle is _________ after pop of ligamentum flavum

A

parrelel

215
Q

inject LA over ___ min

A

2

216
Q

Dose dependent on desired dermatome level

A

VOLUME

217
Q

____% ropivacaine is BEST

A

0.2%

218
Q

2nd best choice: bupivacaine

___-___ ml/kg of ___%

A

0.5**-1 ml/kg of 0.25%

219
Q

Generally: ___ml/kg/dermatome

A

0.5

220
Q

Clonidine __ mcg/kg**

A

1

221
Q

sensory block for T__-__

A

T4-6

222
Q

2 ABSOLUTE CONTRAindications to spinal

A

VP shunt
diaper rash

223
Q

2 RELATIVE CONTRAindications to spinal

A

sacral dimple
history of spinal abnormality

224
Q

How is a child is BEST provided with a regional technique?

A

deep sedation
or
after the induction of GA

principles 3 (4 decks)

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