Mod V: Medication/Cart Set-up Flashcards
(49 cards)
Medication/Cart Set-up
What type of syringes are use to draw up meds in peds?
Draw up meds as “unit dose” syringes

Medication/Cart Set-up
What are “emergency IM dose of SUX & atropine?
SUX (4-6 mg/kg IM)
Atropine (0.02 mg/kg IM)
Draw up syringe & needle
Medication/Cart Set-up
When is this especially important to draw up all the meds you may use during the case?

If you will be hand-ventilating during the case
Medication/Cart Set-up
Which resource can you use as reference for pediatric medication dosages?
Pedi Drug Chart or Reference
Stethoscope
What are benefits of using a stethoscope?
Gives valuable insight into cardiac and respiratory status
Monitored continuously
Stethoscope
Which attachement location of the Precordial stethoscope aloows to monitor/hear both Heart tones & breath sounds?
Apex of heart
Stethoscope
Which attachement location of the Precordial stethoscope offers better listening conditions, is more advantageous during induction/emergence, and can provide an early indication of obstruction/laryngospasm?
Suprasternal notch
Stethoscope
What are the two different types of stethoscope available for use in peds?
Precordial
Esophageal
Have fallen out of favor!!!
Stethoscope
Where is the Precordial stethoscope attached to the pt?
Apex of heart
Heart tones & breath sounds heard
Suprasternal notch
Better listening conditions
More advantageous during induction/emergence
Early indication of obstruction/laryngospasm

Stethoscope
Esophageal stethoscopes are contraindicated in pts with:
Esophageal atresia, or
Esophageal disease

Stethoscope
What can an Esophageal stethoscope that is too large cause?
Tracheal compression distal to ETT
Which can lead to airway obstruction

Blood Pressure
What portion of the limb area should a Blood Pressur cuff cover?
2/3rd of the length of upper arm or thigh (Approx.)
There are specific pediatric sized cuffs
(infants, neonate, premature infant)
Pediatric size cuffs have matched tubing with automated monitors
BP cuff Mismatching could cause false readings

Blood Pressure
Which component of BP (SBP vs. DBP vs. MAP) the BP cuff measurement reasonably accurate for?
SBP
Less for DBP
BP cuff actually measures MAP
SBP and DBP are calculated from MAP
Carbon Dioxide Analyzers
What’s the purpose of Carbon Dioxide Analyzers?
Assess adequacy of ventilation in intubated patients
(less value in mask ventilation)
Carbon Dioxide Analyzers
What renders Carbon Dioxide Analyzers “not perfect”?
Pathophysiologic shunt
Increased A-a gradient
Increased shunting (V/Q mismatching)
Increased deadspace (Vd/Vt)
ETCO2 underestimates PaCO2 in patient with cyanotic congenital heart disease
Low Vt + rapid RR = inaccuracies
Carbon Dioxide Analyzers
What are consequences of increased A-a gradient (Alveolar-Arterial Oxygen Tension Difference) from pathophysiologic shunt?
Increased shunting (V/Q mismatching)
Increased deadspace (Vd/Vt)
Carbon Dioxide Analyzers
In which pts do ETCO2 underestimates PaCO2?
Cyanotic congenital heart disease
(PaCO2 is actually higher than assessed via ETCO2)
Carbon Dioxide Analyzers
How could a low Vt + rapid RR affect EtCO2 readings?
Cause innacurate EtCO2 readings
Perioperative Fluid & Blood Management - Normal Fluid Requirements
There are specific calculations used to ESTIMATE fluid requirements for infants/children. What are other reflections/monitors of volume status used to guide further adjustments?
CVP - HR - BP
U/0
Perioperative Fluid & Blood Management - Normal Fluid Requirements
How are normal fluid requirements calculated based of the Holliday and Segar formula (4-2-1) formula?
This is also known as the (4-2-1) formula
4 ml/kg for first 10 kg of weight
Add 2 ml/kg for the next 10 kg
Add 1 ml/kg for each kg thereafter
or add 40 to weight above 20 kg
Gives you # mL/hr of normal fluid requirements
Perioperative Fluid & Blood Management - Normal Fluid Requirements
What are normal fluid requirements for 12 kg toddler, 2 kg infant, and 25 kg child?
…
Perioperative Fluid & Blood Management - Maintenance
What’s the goal of fluid maintenance?
To replace H20 & electrolytes lost under ordinary conditions
Evaporate (insensible)Urinary
Perioperative Fluid & Blood Management - Maintenance
Althoug Fluid choice is controversial, ideally what do you want to use?
Balanced Salt Solution
(LR or NS)
Perioperative Fluid & Blood Management - Maintenance
When is the use of Glucose containing solutions indicated?
To prevent hypoglycemia during fasting
In accordance with New liberalized fasting guidelines, which ↓incidence of hypoglycemia
When Glucose actually ↑ (d/t stress response)