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Peds Specialty Exam > Jenna's Notes > Flashcards

Jenna's Notes Flashcards

1
Q

What should you do if you do not hear a leak at 20-25 cm H2O?

A

the tube is too large and you need to downsize it

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2
Q

What may be a cause of lower O2 saturation in a baby?

A

prematurity (under 37 weeks( due to underdeveloped lungs

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3
Q

When are the lungs fully developed?

A

after 37 weeks

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4
Q

For how long are premature infants at risk for retinopathy of prematurity?

A

until 44 weeks post conceptual age

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5
Q

What are 2 complications of pt with Pierre Robin syndrome?

A

micrognathia

glossoptosis – tongue falls back into posterior oropharynx

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6
Q

How do you manage the airway obstruction associate with a pt with Pierre Robin syndrome within the first 4 weeks of life?

A

elective trach

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7
Q

How do you determine the appropriate tube size for a ped?

Tube depth?

A

4 + age/4

12 + age /2

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8
Q

LMA size 1 is appropriate for what weight?

LMA size 2?

LMA size 2.5?

LMA 3?

LMA size 4?

A

< 6.5 kg

6.5 - 20 kg

20 - 30 kg

30 - 70

>70

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9
Q

When should you be concerned about loose teeth?

A

6-8 y/o

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10
Q

When does obligate nasal breathing subside?

A

3-5 months

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11
Q

What is the difference in the conducting airways when compared to adults?

A

smaller and narrower trachea and mainstem bronchi

angle of rightstem bronchus is 20 degrees for adult

angle of rightstem bronchus is 30 degrees for peds

very little distance from carina to upper lobe

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12
Q

What is the principle determinant for NG tube size?

A

Pinky finger

Premature = 6 Fr

1 yr = 8 Fr

2 yr = 10 Fr

5 yr = 12 Fr

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13
Q

What is Hb for neonate?

When does physiological anemia occur?

What is the Hb for the physiologic anemic baby?

A

15-20

3 months = physiological anemia

11-12

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14
Q

What is the blood volume of a:

premi
full-term
12 month infant

A

100

90

80

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15
Q

What are normal values for a 6 month, 7kg infant

Hb
HR
SBP
RR
O2 consumption

A

Hb = 11-12

HR 120??

SBP 90

RR 30

O2 consumption 5 ml/kg

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16
Q

When does an infant need endocarditis prophylaxis?

A

dental surgery with a lot of bleeding or manipulation of gingival tissue

respiratory tract incision into mucosa

enterococcus only Gi/Gu

infected skin, muscle tissue

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17
Q

How much drug is given for endocarditis prophylaxis?

A

ampicillin 2 gram

gent 1.5 mg/kg

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18
Q

When does the ductus arteriosus close?

A

after 2-3 weeks

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19
Q

What will keep the ductus arteriosus open?

What will make it close?

A

prostaglandins

indomethacin, ibuprofen (both are NSAIDs)

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20
Q

What may cause stress to the neonate leading to hypoxemia which will promote persistence of fetal circulation?

A

hypothermia leading to increased PVR

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21
Q

What is the path of normal fetal circulation?

A

umbilical vein
placenta
bypass liver –> ductus venosus
IVC
SVC
RA with some to RV
ductus arteriosus
aorta
body
umbilical artery
back to placenta to be re-oxygenated

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22
Q

When does PVR decrease in the newborn?

What is associated with a decrease in PVR?

A

after 2-3 months

closure of patent ductus arteriosus

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23
Q

What is the most common cause of bradycardia in neonate?

A

hypoxemia

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24
Q

What preop labs are needed for a healthy child?

A

None usually

H/H for moderate blood loss

type and cross depends on surgery

ENT may want PT/PTT

need to diagnose hemophilia A before taking tonsils out, for ex.

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25
Q

When should surgery be cancelled in child with URI?

A

purulent rhinitis (green/yellow

fever

elevated wbc with bands (infection)

infiltrate in xray

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26
Q

How do intracardiac shunts affect the rate of induction?

A

if R –> L shunt, takes longer A higher concentration of agent can be used to speed this up, but will take longer to be eliminated

if L –> R, about the same and has negligible effects

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27
Q

What is TAPVR?

A

total anomalous pulmonary venous return

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28
Q

Describe total anomalous pulmonary venous return (TAPVR)

A

pulmonary veins (4) attach to the left atrium normally but in TAPVR, all 4 do not

in order for a person to surive, there must be as ASD to get blood from RA –> LA –> body

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29
Q

What is tetralogy of fallot characterized by?

A

VSD—the hole is usually large and allows oxygen-poor blood in the right ventricle to pass through, mixing with oxygen-rich blood in the left ventricle. This poorly oxygenated blood is then pumped out of the left ventricle to the rest of the body. The body gets some oxygen, but not all that it needs. This lack of oxygen in the blood causes cyanosis.

Pulmonary stenosis—the major issue with tetralogy of Fallot is the degree of pulmonary valve stenosis, since VSD is always present. If the stenosis is mild, minimal cyanosis occurs, since blood still mostly travels to the lungs. However, if the PS is moderate to severe, a smaller amount of blood reaches the lungs, since most is shunted right-to-left through the VSD.

Overriding aorta—the aorta, the main artery carrying blood out of the heart and into the circulatory system, exits the heart from a position overriding the right and left ventricles. (In the normal heart, the aorta exits from the left ventricle.) This is not of major importance in infants.

Right ventricular hypertrophy— Narrowing or blockage of the pulmonaryvalve and/or muscle under the pulmonary valvecoming out of the right ventricle.This restriction to blood outflow causes an increase in right ventricular work and pressure, leading to right ventricular thickening or hypertrophy

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30
Q

How do you treat tet spells?

A

Leg-chest maneuver

Phenylephrine

Beta blockers to prevent overworking of RV

Morphine to depress ventilatory drive

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31
Q

All of the following is associated with congenital abnormalities EXCEPT:

TE fistula
Meningomyelocele
Omphalacele
Gastroschisis
Congenital diagphragmatic hernia

A

Gastroschisis

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32
Q

What surgery should be performed for the infant with OSA?

A

removal of T&A

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33
Q

What is the surgical treatment for otitis media?

What access is needed?

A

placement of ear tubes, a small tube is placed in the eardrum to equalize the pressure within the ear (which increases due to presence of pus and infection) to the atm. pressure

this is called a myringotomy

no vascular access is needed–inhalation induction with LMA

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34
Q

What electrolyte disturbances do you expect with massive blood transfusion?

A

hyperkalemia with old blood –> **acidosis **but resolves on its own due to rapid redistribution

hypocalcemia due to citrate binding to free calcium –> hypotension, cardiac arrest, coagulopathy

hypomagnesiemia because citrate also binds to Mg –> dysrhythmias, hypotension, prolonged QT

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35
Q

What is the protocol for albumin therapy?

A

0.5 - 1 g/kg

around 2.5 - 12.5 gram

if no adequate response after 15-30 min, repeat

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36
Q

How do you resuscitate a pt with bowel obstruction?

A

fluid and electrolyte replacement

usually hypovolemic, acidotic and usually need fluids, blood, and bicarb

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37
Q

When is a child considered hypokalemic?

A

below 3.5

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38
Q

How do you replace fluid deficit in peds?

A

4 ml/kg for first 10 kg. 2 ml/kg for the second 10 kg. 1 ml/kg for every kg over 20 kg

NPO deficit is the maintenance fluid x hours NPO

Replace ½ the fluid deficit during the first hour, ¼ of the deficit + maintenance fluids in the 2nd hour and ¼ of the deficit + maintenance fluid in the 3rd hour.

39
Q

When does pyloric stenosis generally present?

A

2 - 6 weeks of age

40
Q

What is the anesthetic plan for pyloric stenosis pt?

A

RSI because aspiration risk!

Correct fluids and metabolic imbalances first!

41
Q

What is special about extubating the pyloric stenosis pt?

A

DEPRESSION OF VENTILATION

used to living at an alkalotic state –> bradypnea

42
Q

What is the cause of GI obstruction in children?

A

Intussusceptum (like a kaleidoscope), most commonly around 3 months - 6 years

Incarcerated hernia

volvulus

necrotizing entercolitis

43
Q

What is the most common childhood abdominal tumor?

A

**hydronephrosis, **multidysplastic kidney in neonates (hydronephrosis due to obstructtion of ureter, etc.)

neuroblastomas, Wilms’ tumors, and lymphomas are common in children

44
Q

What is pulmonary atresia?

A

a form of heart disease that occurs from birth (congenital heart disease), in which the pulmonary valve does not form properly

In pulmonary atresia, a solid sheet of tissue forms where the valve opening should be, and the valve stays closed. Because of this defect, blood from the right side of the heart cannot go to the lungs to pick up oxygen.

If the person does not have a VSD, the condition is called pulmonary atresia with intact ventricular septum (PA/IVS).

If the person has both problems, the condition is called pulmonary atresia with VSD. This is an extreme form of tetralogy of Fallot.

45
Q

What is pulmonary atresia associated with oftentimes?

What drug can treat it?

A

patent ductus arteriosus

prostaglandins to close the PDA

46
Q

What percentage of the term’s body weight consists of water?

premie?

child?

A

75%

90%

64%

47
Q

When does PVR equal that of adults?

A

2-3 months of life

48
Q

What is IM dose of Sux?

A

4-6 mg/kg

49
Q

What is the main cause of bradycardia in peds pts?

A

HR dependence

50
Q

What results in cardiovascular development?

A

high oxygen consumption, double that of adults

51
Q

What is oxygen consumption of ped pts?

A

6-7 ml/kg/min

52
Q

What does the ductus arteriosus connect?

A

pulmonary arteries with the aorta

53
Q

What does failure of closure of ductus arteriosus cause?

A

L –> R shunt

54
Q

What factors will produce reversion of fetal circulation in newborns?

A

High PVR or pulmonary HTN

Cold stress of neonate that causes pulmonary vasoconstriction

55
Q

What causes fetal bradycardia?

A

hypoxemia

56
Q

What is the initial setting for defibrillation in children?

A

2 Joules/kg

57
Q

What type of shunt increases the time for induction?

A

Right to left

and it also takes longer to wake up

58
Q

How much albumin should be given?

A

2.5 - 12.5 g or 0.5 - 1 g/kg

59
Q

What is the limit of depletion of potassium?

A

3.5

60
Q

What is the most common GI obstruction in peds?

What are others?

A

intussusceptum

malrotation

incarcerated hernias

necrotizing entercolitis

61
Q

What is the most common abdominal tumor?

A

Wilms’ tumors

62
Q

What drug can affect SSEPs by increasing amplitude?

What drug decreases amplitude?

A

etomidate

volatile agents

63
Q

What drug to avoid with SSEP/MEP monitoring?

A

etomidate

64
Q

What LAs can be used in caudals?

A

ropivicaine

bupi

relief for 4-6 hrs

65
Q

How much LA 0.25% bupi is given in a caudal?

A

1 ml/kg

66
Q

How much bupi for a lumbosacral block in a caudal?

A

0.5 ml/kg

67
Q

How much bupi for a thoraco-lumbar caudal block?

A

1 ml/kg

68
Q

How much bupi for a mid-thoracic block

A

1.25 ml/kg

69
Q

What is he max dose of bupi 0.25%?

A

20 cc

70
Q

What is the dose of morphine?

A

0.1 mg/kg

71
Q

What is the IV, IM dose of sux for laryngospasm?

A

IV: 0.5 - 1 mg/kg

IM: 4-6 mg/kg

72
Q

What is the Bain circuit?

A

It is a semi-open coaxial version of the Bain circuit that prevents rebreathing if FGF > 3x minute ventilation

73
Q

What are physical attributes of the breathing circuits for children?

A

lack CO2 absorbent and unidirectional valves

74
Q

What is the correct position for the precordial stethoscope?

A

chest or suprasternal notch

75
Q

What is the dose of Sux IV, IM?

A

2-3 mg/kg IV

4-6 mg/kg IM

76
Q

What are the less obvious reasons to avoid sux in peds?

A

severe bradycardia

crush injuries

77
Q

What is the propofol infusion rate for kids?

A

60 - 220 mcg/kg/min

78
Q

What is EMLA cream comprised of?

A

prilocaine 2.5%

lidocaine 2.5%

need to place for at least 1 hour for 5 mm depth

79
Q

When is MAC highest for peds?

A

2-3 months

80
Q

What drugs are not safe in MH patients?

A

Avoid sux and volatiles

81
Q

What should you do in peds with cardiac dysrhthmias regarding volatile agents?

A

perform a SLOW induction

82
Q

What aldrete score is required before pt discharge?

A

> 8

83
Q

When should infants be admitted overnight for procedures?

A

until 52 weeks post-conceptual age

84
Q

What size blade for premies?

A

miller 00 or miller 0

85
Q

when does normal renal function start?

A

6 months

86
Q

What is the compliance of lungs and chest wall in peds?

A

low lung compliance due to alveolar immaturity

high chest wall compliance

87
Q

How do you calculate CO2 production?

A

8*kg^0.75

88
Q

What is the CO2 response curve in peds?

A

slope increases with gestational age

89
Q

What is the deadspace in infants?

A

2 ml/kg

90
Q

What is the oxygen consumption of infants compared to adults?

A

6 ml/kg

vs. 3 ml/kg in adults

91
Q

How do you manage a pt with left CDH?

A

place chest tube on rt side

92
Q

How do you treat a distended abdomen witth TEF?

A

vent g tube

93
Q

How much fluid in the first 24 hours for a burn?

A

4 ml/kg * BSA burned

94
Q

What is normal glucose for an infant?

A

50

40 is hypoglycemic

Peds Specialty Exam (2 decks)

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