Mod V: Medication/Cart Set-up

Question 1

_{Medication/Cart Set-up}

What type of syringes are use to draw up meds in peds?

Answer 1

Draw up meds as “unit dose” syringes

Question 2

_{Medication/Cart Set-up}

What are “emergency IM dose of SUX & atropine?

Answer 2

SUX (4-6 mg/kg IM)

Atropine (0.02 mg/kg IM)

Draw up syringe & needle

Question 3

_{Medication/Cart Set-up}

When is this especially important to draw up all the meds you may use during the case?

Answer 3

If you will be hand-ventilating during the case

Question 4

_{Medication/Cart Set-up}

Which resource can you use as reference for pediatric medication dosages?

Answer 4

Pedi Drug Chart or Reference

Question 5

_Stethoscope

What are benefits of using a stethoscope?

Answer 5

Gives valuable insight into cardiac and respiratory status

Monitored continuously

Question 6

_Stethoscope

Which attachement location of the Precordial stethoscope aloows to monitor/hear both Heart tones & breath sounds?

Answer 6

Apex of heart

Question 7

_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?

Answer 7

Suprasternal notch

Question 8

_Stethoscope

What are the two different types of stethoscope available for use in peds?

Answer 8

Precordial

Esophageal

_{Have fallen out of favor!!!}

Question 9

_Stethoscope

Where is the Precordial stethoscope attached to the pt?

Answer 9

Apex of heart

^{Heart tones & breath sounds heard}

Suprasternal notch

^{Better listening conditions}

^{More advantageous during induction/emergence}

^{Early indication of obstruction/laryngospasm}

Question 10

_Stethoscope

Esophageal stethoscopes are contraindicated in pts with:

Answer 10

Esophageal atresia, or

Esophageal disease

Question 11

_Stethoscope

What can an Esophageal stethoscope that is too large cause?

Answer 11

Tracheal compression distal to ETT

Which can lead to airway obstruction

Question 12

_{Blood Pressure}

What portion of the limb area should a Blood Pressur cuff cover?

Answer 12

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

Question 13

_{Blood Pressure}

Which component of BP (SBP vs. DBP vs. MAP) the BP cuff measurement reasonably accurate for?

Answer 13

SBP

Less for DBP

BP cuff actually measures MAP

SBP and DBP are calculated from MAP

Question 14

_{Carbon Dioxide Analyzers}

What’s the purpose of Carbon Dioxide Analyzers?

Answer 14

Assess adequacy of ventilation in intubated patients

(less value in mask ventilation)

Question 15

_{Carbon Dioxide Analyzers}

What renders Carbon Dioxide Analyzers “not perfect”?

Answer 15

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

Question 16

_{Carbon Dioxide Analyzers}

What are consequences of increased A-a gradient (Alveolar-Arterial Oxygen Tension Difference) from pathophysiologic shunt?

Answer 16

Increased shunting (V/Q mismatching)

Increased deadspace (Vd/Vt)

Question 17

_{Carbon Dioxide Analyzers}

In which pts do ETCO2 underestimates PaCO2?

Answer 17

Cyanotic congenital heart disease

_{(PaCO2 is actually higher than assessed via ETCO2)}

Question 18

_{Carbon Dioxide Analyzers}

How could a low Vt + rapid RR affect EtCO2 readings?

Answer 18

Cause innacurate EtCO2 readings

Question 19

_{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?

Answer 19

CVP - HR - BP

U/0

Question 20

_{Perioperative Fluid & Blood Management - Normal Fluid Requirements}

How are normal fluid requirements calculated based of the Holliday and Segar formula (4-2-1) formula?

Answer 20

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

Question 21

_{Perioperative Fluid & Blood Management - Normal Fluid Requirements}

What are normal fluid requirements for 12 kg toddler, 2 kg infant, and 25 kg child?

Answer 21

…

Question 22

_{Perioperative Fluid & Blood Management - Maintenance}

What’s the goal of fluid maintenance?

Answer 22

To replace H20 & electrolytes lost under ordinary conditions

^{Evaporate (insensible)Urinary}

Question 23

_{Perioperative Fluid & Blood Management - Maintenance}

Althoug Fluid choice is controversial, ideally what do you want to use?

Answer 23

Balanced Salt Solution

(LR or NS)

Question 24

_{Perioperative Fluid & Blood Management - Maintenance}

When is the use of Glucose containing solutions indicated?

Answer 24

To prevent hypoglycemia during fasting

In accordance with New liberalized fasting guidelines, which ↓incidence of hypoglycemia

When Glucose actually ↑ (d/t stress response)

Question 25

_{Perioperative Fluid & Blood Management - Maintenance}

Maintenance infusion guide for Newborn:

Answer 25

Day 1 => D10W at 50-60 ml/kg/day

Day 2 => D10W with 0.2% NaCl at 100 ml/kg/day

After day 7 => D5W with 0.45% NaCl at 100-150 ml/kg/day

Question 26

_{Perioperative Fluid & Blood Management - Maintenance}

Child maintenance infusion rates:

Answer 26

0-10 kg => 4 ml/kg/hr

10-20 kg => 40 ml/hr + 2 ml/kg/hr

> 20 kg => 60 ml/hr + 1 ml/kg/hr

Question 27

_{Perioperative Fluid & Blood Management - Deficit}

How is Fluid deficit calculated?

Answer 27

Fluid deficit =

[Maintenance requirement x # of hours NPO]

Replace similar to adult (1/2, ¼, ¼)

Question 28

_{Perioperative Fluid & Blood Management - Deficit}

What’s the Fluid of choice to replace Fluid deficit?

Answer 28

BSS, non-glucose containing solutions

^{LR, 1/2NS, pediatric plasmalyte}

^{(Concerns regarding large amounts NS)}

Question 29

_{Perioperative Fluid & Blood Management - Third Space Loss}

Peds Estimation of Third Space Loss is similar to adults

Answer 29

True

Intraabdominal => 6-15 ml/kg/hr

Intrathoracic => 4-7 ml/kg/hr

Intracranial/cutaneous => 0-2 ml/kg/hr

Question 30

_{Perioperative Fluid & Blood Management - Third Space Loss}

Where do Third Space Losses come from?

Answer 30

From ECF losses

Question 31

_{Perioperative Fluid & Blood Management - Third Space Loss​}

Which solution should be used to replace Third Space Losses?

Answer 31

BSS

LR commonly used

Question 32

_{Pediatric Blood Loss Management}

Estimated Blood Volume for Preterm infant (mL/kg)

Answer 32

95-100 mL/kg

Question 33

_{Pediatric Blood Loss Management}

Estimated Blood Volume for Full term neonate (mL/kg)

Answer 33

85-90 mL/kg

Question 34

_{Pediatric Blood Loss Management}

Estimated Blood Volume for Infant (mL/kg)

Answer 34

80 mL/kg

Question 35

_{Pediatric Blood Loss Management}

Estimated Blood Volume for Children > 1y/o (mL/kg)

Answer 35

75 mL/kg

Question 36

_{Pediatric Blood Loss Management}

Estimated Blood Volume for Adults (mL/kg)

Answer 36

70 mL/kg

Question 37

_{Pediatric Blood Loss Management}

Healthy children usually tolerate blood loss well. What’s the acceptable HCT for premature/sick neonates?

Answer 37

40-50%

Question 38

_{Pediatric Blood Loss Management}

Healthy children usually tolerate blood loss well. What’s the acceptable HCT for Healthy/older children?

Answer 38

20-26%

Question 39

_{Pediatric Blood Loss Management​}

How is MABL calculated?

Answer 39

​​MABL= EBV X [(Starting Hct – Target Hct) / (Starting Hct (or average Hct)]

Question 40

_{Pediatric Blood Loss Management​}

What’s the MABL for a 10 kg Infant, with HCT of 42, and will allow to fall to 25%?

Answer 40

….

Question 41

_{Pediatric Blood Loss Management}

All blood losses must be measured as accurately as possible. What are methods to accomplish this?

Answer 41

Weigh sponges (1gm = 1cc)

Smaller suction canisters

Question 42

_{Pediatric Blood Loss Management}

Replacement of blood loss <1/3 EBV with:

Answer 42

Crystalloids: 3:1

Question 43

_{Pediatric Blood Loss Management}

Replacement of blood loss >1/3 EBV with:

Answer 43

Colloids: 1:1

Question 44

_{Pediatric Blood Loss Management}

Replacement of blood loss > ABL with:

Answer 44

PRBC’s

Question 45

_{Pediatric Blood Loss Management}

How to determine volume of PRBC’ s to transfuse?

Answer 45

EBV X [(Desired Hct - Present Hct) /

Hct of PRBC’ s (55-75%)]

Question 46

_{Pediatric Blood Loss Management}

Determine the volume of PRBC’s to transfuse in this case:

^{5 kg infant has dropped to 23%, you realize there may be more blood loss intra- and postop, HCT of 1U PRBC’ s is 70}

Answer 46

400 X [(30 – 23)/70] = 40 ml PRBC

Question 47

_{Pediatric Blood Loss Management}

1ml/kg of PRBC ↑HCT by

Answer 47

1.5%

Question 48

_{Pediatric Blood Loss Management}

10ml/kg of PRBC ↑ Hgb by

Answer 48

1-2 gm/dl

Question 49

_{Pediatric Blood Loss Management}

PRBC units are divided into pediatric packs of what volume?

Answer 49

50-100 mL