Final, Pedo Flashcards
Child physiology differs from adults in these ways
Metabolism
Cardiovascular response
Airway anatomy
Child emergencies most often involve what?
Respiratory compromise- AIRWAY!
Child’s airway anatomy
Larynx is more superior and anterior and has immature cartilage
Tongue is larger, and higher in mouth
Tonsils are more prominent
Head is larger proportionally
Oxygenation DEF
Transport of oxygen to metabolically active tissues
Children ventilation
Children breath faster and have smaller tidal volumes - overall take in less oxygen
Brodsky Scale
If tonsils are greater than half the airway, likelihood of blockage inc dramatically
Do NOT sedate with chloral hydrate or meperedine if kissing tonsils
If have kissing tonsils, don’t sedate with these drugs!!!
Chloral hydrate or Meperidine
Mallampati Scale
View for intubation- quality of peritonsillar tissue
Respiratory Problems
Prematurity
Early Life Intubation/Apnea
Respiratory Syncitial Virus
Asthma
Premature Birth
Delayed development of airway–> reduced levels of surfactant
Usually have early life intubation–> will have inc post-extubation scarring
Can have impact on muscle tone, reflex arc, laryngospasm tolerance level
Early Life Intubation
Post-intubation tracheal stenosis
Hyperoxgenation - bronchopulmonary dysplasia- pulmonary scarring, chronic inflammation, rt side heart failure, subglottic stenosis
RSV
Virus infecting >90% but only 2% are symptomatic
Affects up to 125k in US each year
RSV Risk factors
Male
Household crowding
Daycare
Gestational age
Most common cause of bronchiolitis and pneumonia in children
RSV
RSV and oral sedation
Inc reactivity to airway–> resp depression
Can predispose to asthma hyper reactivity too
Asthma
Affects over 6 mil children
2nd most common chronic illness
Asthma meds
Controllers: B agonists and Leukotriene inhibitors
Rescue Meds: Albuterol
Steroid
Aspiration Risk Assessment
Lower esophageal pressure
Floppy sphincters
Reflexes not intact
Acidity and volume of gastric contents
Guidelines for eating drinking before Sedation
Good - 8 hours
Formula- 6 hrs
Breastmilk - 4 hrs
Clear liquid - 2 hrs
N2O
Can be truly titrated
Can have potentiating effect with other sedatives
Can produce suppression or airway reflexes (swalloing) at 50% concentration
Chloral Hydrate: class, dose, effects
Hypnotic
Dose: 20-50 mg/kg
Effects: at 20-35mg - disinhibition, giddiness, irritability, anger, somnolence?
35-50mg - no giddiness, more somnolence
Are hyperactive first 20 min, then somnolence till 90 min
Chloral Hydrate Adverse Effects
Dec resp rate inc airway blockage inc cardiac arrythmias inc mucosal irritation inc vomiting inc drug-interactive effects NO reversal agent
Meperidine: class, dose, effects
Narcotic 1-2 mg/kg Euphoria/dysphoria Analgesia Mood depression irritability obtunded responsiveness Takes about 20 min and last till 90
Meperidine Adverse Effects
Dec resp rate Inc myocardial depression Inc seizures Inc vomiting Inc drug-interactive effects
Midazolam: class, dose, effects
Benzodiazepine 0.2-1.0 mg/kg Mood change relaxation less reactive to stimuli QUICK onset (5 min) SHORT duration (20 min)
Drugs interactions with Midazolam
Narcotics inc adverse effects
Antihistamine - prolong effects
Midazolam administration
Oral 0.2-1.0 mg/kg oral
Intranasal - faster onset and recovery
Midazolam adverse effects
Resp rate decrease
Inc hiccups
Inc cardiac arrest
Inc interactive drug effects
Doses and Max amounts:
Meperidine
1-2 mg/kg
50 mg
Doses and Max amounts:
Chloral Hydrate
20-50 mg/kg
1 g
Doses and Max amounts:
Hydroxyzine
1-2 mg/kg
50 mg
Doses and Max amounts:
Diazepam
0.25-0.5 mg/kg
15 mg
Doses and Max amounts:
Midazolam
0.3-1.0 mg/kg
15 mg
Sedation med flavors Phenergan Versed Demerol Atarax
Phenergan - lime
Versed- cherry
Demerol - vomit
Atarax- lime
Agents for Easy procedures
Midazolam
For more difficult procedures
Midazolam + demerol
For difficult and long cases agents
GA
