Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pediatrics > Final > Flashcards

Final Flashcards

1
Q

Cardiac and CNS toxicity may occur virtually simultaneously in infants and children due to

A

Lower threshold for cardiac toxicity with bupivacaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

CNS and CV signs of LA toxicity include

A

Circumpolar numbness

Paresthesias

Lightheaded

Tinnitus
Seizure

Respiratory depression/arrest

Ventricular arrhythmia

Cardiac arrest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Why is resuscitation effort after bupivacaine toxic dose difficult

A

Bupivacaine has affinity for Na, K, and Ca channels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Bupivacaine is highly bound to plasma proteins specifically what 2 proteins

A

Alpha 1 acid glycoprotein

Albumin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Lower levels of plasma proteins leads to what with bupivacaine

A

Increased free (unbound) fraction of LA that produces toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

After accidental injection of large IV dose of bupivacaine progression from prod royal signs to CV collapse timeline

A

May be rapid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

To terminate seizure activity what drugs given

A

Midazolam 0.05-0.2 mg/kg

Thiopental 2-3mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

If cardiac arrest from LAST think

Treatment of choice

A

Intralipids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Dose of intralipids

A

1.5ml/kg of 20% IV lipid emulsion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Max dose of intralipids

A

3ml/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Maintenance infusion rate of intralipids

When stop?

A

0.25 ml/kg/min

Until circulation restored

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Is propofol recommended as substitute for intralipids for LAST

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Supportive treatment of LAST with intralipids

A

IVF 10-20ml/kg isotonic

Vasopressors (NE or neo)

Antiarrythmic

Phenytoin

ECMO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Conus medularis is located where in peds

Adults

A

L3 in peds up to 1 yr old

L1 adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Lumbar puncture for SAB/spinal in neonates and infants is performed at what level

A

L4-L5

L5-S1

Avoid needle injury to SC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Tip of spinal cord in neonate ends at what level

When achieves normal adult position of L1-L2

A

L3

1 year of age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Neonatal sacrum differences from adults

A

Narrower and flatter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

LP in older child may be performed where

A

L2-L3

L3-L4

L4-L5

L5-S1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

At birth spinal cord ends at what level

A

L3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

LP in infant may be performed at what levels

A

L4-L5

L5-S1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Presence of deep sacral dimple may be associated with

A

Spina Bifida Occulta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Presence of deep sacral dimple implications with caudal anesthesia

A

Greatly increases probability of dural puncture

Caudal block contraindicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

CSF volume as percentage of body weight in infants/young children compared to adults

A

Greater in infants/young children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

CSF turnover rate for infants and children compared to adults

A

Greater turnover rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Greater turnover rate of CSF in peds results in what changes in SAB

A

Much briefer duration compared to adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

SAB and epidural in infants and small children has what hemodynamic effect

A

Hemodynamically stable even when reaches upper thoracic levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Why clinically significant BP changes do not occur in young children with SAB and epidural

A

PNS stronger than SNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What position is patient placed into for caudal epidural

A

Lateral decubitus position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Palpate what for caudal epidural

A

Cornu of sacral hiatus

Found at the beginning of the crease of the buttocks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Appropriate insertion site of caudal epidural

A

Slightly more caudal from palpate sacral Cornu

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What size IV cath for caudal block

A

22G

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Needle direction initially for caudal block

A

45 degrees cephalad bevel down

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Needle passes through what ligament for caudal block

A

Sacrococcygeal ligament

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What space is caudal block placed into

A

Caudal canal

Continuous with epidural space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

If bone is encountered before sacrococcygeal ligament do what

A

Withdraw several mm

Decrease angle to 30 degrees

Gently advance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

As advance needle for caudal block what adjustments to angle

A

Decreased angle and nearly parallel to plane of child’s back

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Intraosseous injeciton of LA results in what uptake

A

Very rapid uptake

Similar to direct IV injection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Drug dose for epidural blockade to a given dermatome level depends on what

A

Volume not concentration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Concentration of LA for epidural should be based on what

A

Desired density of block

Risk of toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Where does spinal cord end in neonate

A

Lower border of L3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Neonate is undergoing surgical procedure with spinal. What would indicate high or total spinal?

A

Decreasing sat is earliest sign

Respiratory insufficiency rather than hypotension

CV markers stable bc PNS dominant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is maximum dose of 0.25% bupivacaine that should be used for pediatric caudal anesthesia

How long anesthesia provided

A

1 ml/kg up to max of 25ml

Provides 3-6 hours for procedures below the diaphragm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Appropriate volume for pediatric epidural blood patch

Awake

Anesthetized

A

Awake- stop when child feels discomfort or pressure

Anesthetized- max 0.3ml/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Leading cause of death an disability in peds

A

Injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Up to 40% of polytrauma patients die as a result of what

A

Circulatory shock from acute blood loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Besides surgical control of hemorrhage what is crucial for survival

A

Adequate volume resuscitation with blood products and IVF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Most common cause of death from injury for victims of all ages

A

Traumatic brain injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Major threat to children in US

A

Vehicular trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Initial management and definitive care of child with traumatic head injury is focused on

A

Optimizing cerebral perfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Why optimize cerebral perfusion

A

Minimize extension of injury

Maximize recovery of damaged neuron

Managing extracranial injury simultaneously

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Primary goals in management of peds trauma pt (9)

A

Delivery of oxygen

Appropriate ventilation

Vital organ perfusion

Normothermia to mild hypothermia

Assure renal function

Neurological stability

Correct coagulopathies

Avoid overhydration

Meticulous mgmt of metabolic demands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

In emergency and shortage of 0- blood boys can receive what type

A

B+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Prepare for trauma patient with what in regards to weight

A

Estimated weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Lidocaine bolus and infusion

A

1mg/kg bolus

20-50mcg/kg/min infusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Adenosine dose

A

100 mcg/kg rapid bolus
Max 6 mg

200mcg/kg second dose
Max 12 mg

56
Q

Amiodarone dose

A

5mg/kg

Max 300mg

VF and VT

57
Q

Procainamide dose

A

5-15 mg/kg over 30-60min

Then 20-80mcg/kg/min infusion

58
Q

Magnesium IV dose

A

25-50 mg/kg
Max 2 gm

Torsades

59
Q

Calcium chloride dose

A

10-20mg/kg

Central line. Slowly

Stronger. More Ca per ml

60
Q

Calcium gluconate dose

A

30-60mg/kg

PIV ok

61
Q

Epinephrine

Hypotension

Cardiac arrest

A

1 mcg/kg hypotension

10mcg/kg arrest

62
Q

Atropine max dose

Child

Adolescent

A

Child 1 mg

Adolescent 2 mg

63
Q

No time for type and cross what blood given

A

O PRBCs

AB platelets and plasma

64
Q

Women of childbearing potential should receive what type of blood

A

O negative RBC

65
Q

Men and women post-childbearing age could receive what type

A

0 positive PRBCs

66
Q

PRBCs 4 ml/kg increases Hgb bu how much

67
Q

What dose of PRBCs increases Hgb by 1 g/gL

68
Q

Platelet transfusion of what dose increases platelet count 50K-100K

A

5-10 ml/kg

69
Q

FFP transfusion of how much increases factor level by 15-20%

A

10-15ml/kg

70
Q

Platelet infusion of 5-10ml/kg will increases platelet count by how much

A

50,000-100,000

71
Q

FFP transfusion of 10-15ml/kg increases factor level by how much

72
Q

Cryoprecipitate given to increase what level

A

Fibrinogen

73
Q

Cryo dose of 1-2 units/kg increases fibrinogen how much

A

60-100 mg/dL

74
Q

To increase fibrinogen by 60-100mg/DL dive how much cryo

A

1-2 units/kg

75
Q

Lethal trauma triad of death

A

Coagulopathy

Acidosis

Hypothermia

76
Q

How coagulopathy leads to acidosis

A

Increased lactic acid in blood

77
Q

How acidosis to hypothermia

A

Decreased heart performance

78
Q

Hypothermia to coagulopathy

A

Decreased coagulation

79
Q

Platelets should/should not be refrigerated

80
Q

If overt signs of bleeding present or more hemostatic challenging procedure imminent what platetlet level may be required

A

30,000 to 50,000/mm3

81
Q

Platelet should be give through what type of filter

A

Large-pore filters

> 150nm

82
Q

FFP contains what

A

All clotting factors and regulatory proteins

83
Q

What patients could benefit from higher FFP:RBC ratio of 1:1

A

Massively transfused patients

84
Q

Increased FFP transfusions to massively transfused patients associated with

A

Trend toward increased mortality

Increased risk of TRALI

85
Q

Rapid administration of FFP can cause

A

Citrate toxicity

86
Q

S/S hypochloremia

A

Hypotension and arrhythmias

87
Q

Citrate intoxication may be more likely in setting of

A

Hypothermia, liver disease/transplantation

More likely in pediatric patients

88
Q

Citrate is mainly metabolized where

89
Q

Citrate has what effect in blood stream

A

Binds calcium

90
Q

Cryoprecipitate contains what factors

A

Factor VIII

Von willebrand factor

Factor XIII

91
Q

Cryoprecipitate indicated for what

A

Factor XIII deficiency

Dysfibrinogenemia

Hypofibrinogenemia

92
Q

MABL formula

A

EBV X (Hct-maHct)
—————————-
Hct

Minimum accepted Hct (maHct)

93
Q

Cryoprecipitate contains how much factor VIII from original plasma unit

94
Q

Formula for volume of PRBCs to be transfused

A

EBV X (desired Hct - current low Hct)
————————-
Hct of PRBCs- 60

95
Q

Hct of unit of PRBCs

96
Q

Child with severe pulmonary disease or cyanotic heart disease requires ___________ Hct than healthy child

A

Higher Hct

97
Q

Preterm infants may require _______ Hct

98
Q

Why do preterm infants require higher Hct

A

To prevent apnea

Reduce cardiac and respiratory work

Improve neurologic outcomes (possibly)

99
Q

If little potential for post op bleeding Hct level of _____ is acceptable in healthy infants put to 3 months

100
Q

If little potential for post op bleeding what Hct is acceptable in older healthy children

> 3 months

101
Q

Risk of spine injury in peds patient is increased when child is subjected to (2)

A

Inertial forces from falls

Chaotic rotary forces from MVA

102
Q

Any child with suspected neck injury should have

A

C spine precautions

103
Q

_________ should always be maintained when airway manipulation attempted in suspected neck injury

A

In line stabilization

104
Q

How many people may be required to intubate child with cervical fracture

Roles

A

4

1 for inline stabilization

1 to do intubation

1 for cricoid, hold ETT

1 to give drugs

105
Q

Initial management of severe brain injury must first focus on

A

Actual pathophysiologic process that occurred at point of impact

106
Q

Useful for initial and ongoing assessments of severity of CNS injury

A

GCS

Modified GCS for peds patients

107
Q

Regardless of whether brain injury due to trauma or secondary due to global hypoxia there is

A

Immediate disruption of integrity of BBB

Results in cerebral edema and diminished neuronal oxygenation

108
Q

Modified GCS for peds

Verbal response rankings

A

5- babbles, coos

4- cries but inconsolable

3- persistent crying or screaming in pain

2- grunts or moans to pain

1- none

109
Q

Modified GCS is applicable to what patients

A

Eye opening and motor < 1 yr

Verbal response < 2 years

110
Q

Children with head trauma may have minimal neurologic abnormalities at time of initial evaluation, however

A

Increased ICP and neurologic deficits may progressively develop

111
Q

Increased ICP and neurologic deficits occur slowly in how many stages

112
Q

2 stages of brain injuries

A

Primary insult

Secondary insult

113
Q

Primary insult of deficit occurs when

Results from

A

Time of impact

Results from biomehcanical forces that disrupt cranium, neural tissue, and vasculature

114
Q

Secondary insult of neurologic deficit is

Results from

A

Parenchymal damage caused by sequence subsequent to primary insult

Results from hypotension, hypoxia, cerebral edema, or intracranial hypertension

115
Q

Ventilation of children with cerebral injury should maintain PaCO2

A

Between 35-40 mm Hg

116
Q

Avoid/do mild hyperventilation in patient with cerebral injury

117
Q

Hyperventilation even mild should be avoided. Why?

A

Decreased blood flow to area surrounding injured area. Worsening flow to area

118
Q

Calming the brain involves

A

Immediate administration of opioids and benzos

Seizure prophylaxis

alters neuro exam

119
Q

What commonly given for seizure prophylaxis

A

Phenytoin

Phenobarbital

120
Q

____________ should be considered when caring for children with AMS, Sz, or associated trauma requiring surgery

A

Basilar skull fracture

121
Q

Findings associated with basilar skull fracture

A

Raccoon eyes

Retro auricular ecchymosis (battle sign)

Hemotympanum

Clear rhinorrhea

Otorrhea

122
Q

Avoid what in possible basilar skull fracture

A

nasal intubation

NG tube

123
Q

Acute subdural hematoma is most dangerous. Generally caused by what

A

Severe head injury

124
Q

S/S of acute subdural hematoma occur when

A

Immediately usually

125
Q

Due to rupture of usually veins between brain and dura

A

Subdural hematoma

126
Q

Rupture of blood vessel between dura and skull

A

Epidural hematoma

127
Q

Epidural hematoma

What BV usually rupture

128
Q

As epidural hematoma expands leads to what s/s

A

Loss of consciousness

Hemiparesis

Pupillary dilation

129
Q

Treatment of epidural hematoma

A

Prompt surgical evacuation

130
Q

Medical therapy with epidural hematoma should be aimed at

A

Decreasing ICP

131
Q

Acute subdural hematoma is almost always r/t

A

Trauma and frequently result of abuse

132
Q

Shaken baby syndrome leads to what

A

Acute subdural hematoma

133
Q

MOA of shaken baby syndrome

A

Infant so vigorously shaken that accelerating and decelerating rotational forces cause bridging veins to rupture

134
Q

Blood vessels most susceptible with shaken baby syndrome

A

BV leading from brain to dura

135
Q

In 50-80% of shaken baby syndrome what is presence

A

Unilateral retinal hemorrhage

136
Q

Any bruises in what areas must be suspect for abuse

A

Buttocks

Groin

Neck

Cheeks

137
Q

Age of children at highest risk for maltreatment and subsequent mortality

A

3 and under

Pediatrics (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions