ITE Peds 3 Flashcards
In a neonate, how do you treat a tension pneumothorax?
22g blunt needle or angiocatheter inserted in ipsilateral second intercostal space at midclavicular line,
then insert ped thoracostomy tube
A newborn with a birth complicated by meconium has a __% chance of developing a PTX
10%
Cobb angle > __ degrees is indication for surgical intervention d/t worsening of pulmonary complications
40
How to intubate pts with halo cervical placement
intubate w/o ablating the pt’s ability to spontaneously breathe
Why are neonates predisposed to hypervolemia in setting of overly aggressive volume resuscitation?
immature kidneys excrete less water and electrolytes
Peds pt with
- asymmetric face
- one sided coloboma (hole in structure of eye)
- ear tag
- micrognathia
Goldenhar syndrome
- vascular accident affecting 1st and 2nd branchial arches
Peds pt with:
- craniosynostosis (premature cranial suture ossification)
- Hypertelorism (inc distance btwn orbits)
- shallow orbits causing ocular proptosis
- maxillary hypoplasia
- Parrot-like beaked nose
- NO micrognathia
Crouzon syndrome
Peds pt with:
- Micrognathia
- glossoptosis (displacement of tongue towards pharynx)
- cleft palate
- BILATERAL
- does not involve ears and eyes
Pierre Robin Sequence
Peds pt with:
- underdevelopment of bones of upper jaw
- downslanting palpebral fissures
- coloboma of lower eyelid
- ear abnormalities
- normal intelligence
Treacher collins
- more dysmorphic than robin or goldenhar pts
Peds pt with
- intellectual disability
- short stature
- multiorgan involvement
- abnl facies
- abundant secretions
- large tongue
- short neck
Hurler syndrome
- AR disorder
- abnl a-L-iduronidase
5 congenital abnormalities (Goldenhar, Robin, Treacher collins, crouzon) are associated with OSA, ____ has been reported to be useful in all of them
Supraglottic airway devices (LMA)
Propofol infusion syndrome is assoc w/ ___ (4)
- rhabdomyolysis
- Lactic acidosis
- Renal failure
- cardiac failure
A newborn lung is (more/less) compliant compared to adults, and chest wall is (more/less) compliant
Lung - less
chest wall - more
MH complications (7)
- Rhabdo
- Myonecrosis
- renal failure
- hyperkalemia
- arrhythmias
- DIC
- Death
Early warning signs of MH
- tachycardia
- tachypnea
- inc ETCO2
- masseter muscle spasm
Postconceptual age definition
gestational age + age after birth
Postconceptual age of __ weeks correlates to < 1% postop apnea
56
______ is the strongest risk factor for post op apnea
prematurity
(Centrifugal/Roller) pump flow varies with changes in pump preload and afterload
centrifugal pump
Roller and centrifugal pumps can deliver adequate systemic pressure during CPB periods via (pulsatile/non pulsatile) flow
non-pulsatile
(Centrifugal/Roller) pump flow is essentially only dependent on the speed of the rollers
roller
(Centrifugal/Roller) pumps have higher incidence of blood element destruction, creation of microemboli, and inflow/outflow obstructions
roller pumps
(Centrifugal/Roller) pumps are preferred in cardiopulmonary bypass circuits
Centrifugal
Recite the normal values CVP: PCWP: CI: SVR:
CVP: 2- 6 mmHg
PCWP: 6 - 12 mmHg
CI: 2.5 - 4 L/min/m2
SVR: 800-1200 dynes*sec/cm5
All types of shock except ___ has lowered Cardiac output/index
septic
Name that shock!
- Decreased CVP
- Decreased PAP (pressure after RH)
- Increased PVR
- Decreased LVEDP
- Decreased CO
- Increased SVR
Hypovolemic
Name that shock!
- Decreased SVR
- Decreased CVP
- Decreased PAP (pressure after RH)
- Decreased PVR
- Decreased LVEDP
- Increased CO
Septic (Distributive shock/vasodilatory)
Name that shock!
- Increased LVEDP
- Decreased CO
- Increased SVR
- Increased CVP
- Increased PAP (pressure after RH)
- Increased PVR
Cardiogenic
Name that shock!
- Increased PAP (pressure after RH)
- Nothing PVR
- Increased LVEDP
- Decreased CO
- Increased SVR
- Increased CVP
Cardiac tamponade
Name that shock!
- Increased PVR
- (-/decreased) LVEDP
- Decreased CO
- Increased SVR
- Increased CVP
- Increased PAP (pressure after RH)
Pulmonary embolism
Name that shock!
- Decreased CO
- Decreased SVR
- Decreased CVP
- Decreased PAP (pressure after RH)
- Decreased PVR
- Decreased LVEDP
Neurogenic (Distributive/vasodilatory shock)
- dec CO is from spinal shock/bradycardia
Initial landmark identified when performing lateral femoral cutaneous nerve block
anterior superior iliac spine
Lateral femoral cutaneous nerve
- provides sensory innervation to ____
- derived from __ nerve roots
anterolateral thigh
L2-L3
How do you perform a Lateral femoral cutaneous nerve block
1 cm medial and 1cm inferior to ASIS, where LFCN is located btwn sartorius and tensor fascia lata
Condition where damage to LFCN leads to pain and paresthesias on the lateral upper thigh, which may extend to lateral knee
meralgia paresthetica
*LFCN can be entrapped btwn inguinal ligament and the ilium
Which one allows passive expiration?
High frequency jet ventilation v
High frequency oscillatory ventilation
High frequency jet ventilation
- other wise auto-peep can develop
Which one allows setting a specific tidal volume?
High frequency jet ventilation v
High frequency oscillatory ventilation
neither
In both
High frequency jet ventilation and
High frequency oscillatory ventilation, CO2 removal is (directly/indirectly) proportional to frequency
inversely
- higher the frequency, the lower the amplitude (key to CO2 removal)
____ most common valvulopathy associated with RA
Mitral valve disease
Aortic regurgitation
Airway concerns in pts with RA (3)
- atlantoaxial subluxation
- TMJ synovitis limit mandibular motion
- Cricoarytenoid arthritis
- hoarseness, pain on swallowing, post-extubation laryngeal obstruction
Respiratory alkalosis results in (Hyper/Hypo) calcemia and (Hyper/Hypo)kalemia
Hypocalcemia
- Alkalosis –> H+ ions bound to negatively charged albumin is released to offset alkalosis –>
Ca2+ binds to albumin
*paresthesias can occur with hyperventilation
Hypokalemia
- H-K transporters pump H+ out of the cell and K+ intracellularly
Wind up phenomenon is caused by repeated stimulation of ___ fibers, increasing action potentials at dorsal horn -> amplified response
C
When should EPI be administered in non-shockable rhythms?
ASAP
When should EPI be administered in shockable rhythms?
defib, then 2 min CPR then defib, then epi
The foot is innervated by 5 nerves, but only 4 can be blocked at the ankle. Name them
- Posterior tibial
- Sural
- Superficial peroneal
- Deep peroneal
Law that says that a change in gas volume is inversely related to pressure on the gas
boyle law
