Focus Flashcards
What is PAOP equal to?
Left atrial pressure and PAOP and LVEDP should all be equal
Which conditions have a big tongue ?
Big Tongue
B - Beckwith syndrome
T - Trisomy 21
Which conditions have a small or underdeveloped mandible?
Please Get That Chin
P - Peirre Robin
G - Goldenhar
T - Treacher Collins
C - Cri du Chat
What is Pierre Robin?
Think of a Robin
- Small chin
- Usually need to be intubated
- Tongue that falls backward
- Cleft Palate
What is Treacher Collins?
Look like a teacher?
No chin
Small mouth
Nasal airway blocked
Physical signs of Trisomy 21
Small mouth
Large Tongue
Atlantoaxial instability
Small subglottic diameter
What is Klippel-Feil ?
Neck rigidity from fusion of cervical vertebrae
What is Goldenhar?
Small mandible
Cervical instability
What is Beckwith syndrome?
Large tongue
What is Cri du chat?
Small mandible
Laryngomalacia
Stridor
Airway specifics for Cleft Lip/Palate?
-Poor airway
-Aspiration
-Difficult DL
-Difficult mask
-Obstruction
-Failure to thrive
When is Cleft lip usually repaired?
1 month
When is Cleft palate usually repaired?
12 months
What is the Dingman-Dott retractor?
Reduces venous drainage and cause tongue engorgement
At risk for post extubation airway obstruction
Most common cardiac anomaly with Down syndrome?
Atrioventricular septal defect
Second is VSD
What is Vacterl association?
VACTERL
V - Vertebral defects
A - Imperforated anus
C - Cardiac anomalies
T - Tracheoesophageal fistula
E - Esophageal atresia
R - Renal Dysplasia
L - Limb anomalies
What is charge association?
CHARGE
C- Coloboma (hole in eye)
H - Heart defects
A -Choanal atresia (nasal blockage)
R - Restriction of growth
G - Genitourinary problems
E - Ear problems
What is catch 22? Another name?
CATCH 22
DeGeorge syndrome
C - Cardiac defects
A - Abnormal face
T - Thymic hypoplasia
C - Cleft Palate
H - Hypocalemia
22 - 22 gene deletion
What are the two facts about DiGeorge Syndrome ?
May have hypocalemia
High risk for infection due to thymus being absent
What type of blood is best to be transfused to DiGeorge syndrome?
Leukocyte-depleted irradiated blood
What is the most common coagulation disorder for kids undergoing a T&A?
wvF disease
What drug is used to treat wVF?
DDAVP
What are kids at risk for when receiving DDAVP?
Hyponatremia
What is the most common cause of OSA in kids? What is the most common cause of indication for removing tonsils?
Tonsil hypertrophy
- OSA ( sleep disorder )
- Recurrent infections
What drug should kids undergoing a T&A not receive ?
Codeine (FDA warning)
Risk of resp depression and death
How long should kids be admitted to the hospital for a T&A?
23 hours
Do kids undergoing a T&A have a longer or shorter emergence?
Longer
Should kids undergoing a T&A receive lower or higher opioids?
Lower
Use precedex and ketamine
How should fluids be calculated for a kid getting DDAVP?
Cut the fluid rate in half
What drug should be given for a T&A? Why?
1mg/kg dexamethasone
Reduces swelling, pain, and PONV
Is there a risk for airway fire during a T&A?
Yes turn FiO2 < 40%
Avoid nitrous
Okay to suction after a T&A?
Yes but be careful, stay midline
Highest risk for primary postop bleeding after a T&A?
Within 24 hours
75% happen within 6 hours
Highest risk for secondary postop bleeding?
5-10 days postop when the scar covering contracts
Post op T&A bleed? How should they be managed?
RSI
Treat as full stomach from swallowing blood
Left later, head down
Give fluids
OGT to decompress the stomach
Lowest acceptable age in weeks for same day surgery
60 weeks
Most common metabolic disturbance in the newborn?
Hypoglycemia
Which two conditions should be looked for in a preoperative interview for a T&A?
OSA
Bleeding disorder
(Most common is Von willebrand)
Most common indication for a liver transplant <2 years old?
Biliary atresia
