Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Resp S21 > Neo/peds > Flashcards

Neo/peds Flashcards

1
Q

Normal pulse

A

130-160

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Normal respiratory rate

A

40-60

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Ductus venosus

A

Allows blood to go from the umbilical vein, bypass the liver and connect to the IVC short cut to inferior vena cava

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Foramen Ovale

A

Opening between the atria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Ductus arteriosus

A

the connection between the pulmonary artery and arota

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Deceleration

A
  • temporary decrease in fetal HR during contraction
  • decrease of 15-45 beats/min is considered a decel
  • early deceleration in relation to contractions is normal
  • late or variable declaration may indicate fetal stress and is often related to reduced blood flow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What does the Silverman score assess?

A

assess respiratory distress, work of breathing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does the Ballard score assess?

A

estimate the gestation age

best 0, worst 10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

At what HR do i start PPV? Compressions?

A

HR <100: PPV

HR <60: Compressions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What changes result in the closure of the fetal anatomic shunts?

A
  • Pulmonary vascular resistance decreases
  • systemic vascular resistance increases
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How many grams in 1 pound?

A

454 gm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Acrocyanosis

A

cyanosis of the hands/feet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is Pallor?

A
  • ashin/grey color
  • indicates blood loss
  • shock
  • blood redistribution
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is central cyanosis?

A
  • Cyanosis on all perfused surfaces
  • R to L shunting
    • Congenital heart disease
    • persistent fetal circulation
    • pulmonary/RDS
    • CNS distrubances
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the goals of oxygen therapy in neonates?

A
  • Treat hypoxemia
  • <32 wk: 88-92%
  • >32 wk: 90-95%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are some hazards of O2?

A

ROP

BPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is Retinopathy of Prematurity(ROP)?

A
  • Loss of vision
  • immature retinal vasculature constricts in response to elevated O2 tension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is bronchopulmonary dysplasia (BPD)?

A
  • Chronic lung disease associated with high levels of O2 and mechanical ventilation for an extended time
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is a Neutral thermal environment?

A
  • allows neonates to maintain normal internal temperature without increased O2 consumption
  • neonates have a large body surface area to mass ratio causing them to loss heat fast
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Indications for CPAP

A
  • Refractory hypoxemia
  • obstructive apnea- stabilize soft tissue to relieve obstruction
  • Central apnea- can stimulate respiration in some infants
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the process for the initiation and application of CPAP?

A
  • start at setting 4-5 cmH2O
    • use same FiO2 from device they were moved fro,
  • increase CPAP in increments of 2-3 cmH2O per dr. order
  • flow range from 5-10 LPM
  • Max of 12cmH2O (10 is high)

try to maintain adequate PaO2 mmHg with FiO2 of 0.5 or less

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How can we reach an NTE?

A

Incubator or warming lights

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the advantages of Pressure control?

A
  • Infants use cuffless tubes which would cause volume loss if using VC
  • able to regulate peak pressure and decrease the risk of barotraume
  • volume loss due to tubing compliance is not an issue
24
Q

What are the disadvantages of pressure ventilation?

A
  • volume is variable and dependent on changes in the respiratory system mechanics (AKA resistance and compliance)
  • Risk of volutrauma
25
Q

What is pressure control/volume guarantee?

A

allows for a set volume target while maintaining the pressure control mode. Won’t go full Vt if it hits the max pressure allowed

26
Q

What are the intial pressure control ventilatory settings for an infant?

PIP
PEEP
Frequency

Itime

Etime

I:E ration

flow rate

FiO2

A
  • PIP: 16-20 (titrate to 4-6ml/kg)
  • PEEP: 5 cmH20
  • Frequency: 20-40
  • Itime: 0.3-0.5 sec
  • Etime: 0.6 or greater
  • I:E ration: 1:2 or greater
  • flow rate: 6-12 LPM
  • FiO2: try to keep = 50
27
Q

What is the target Vt in mechanical ventilation of an infant and pediatric patient?

A
  • Infant: 4-6 ml/kg
  • pediatric: 6-8 ml/kg
28
Q

What is normal compliance in a neonate?

A

2.5-5 ml/cmH20

29
Q

Criteria for weaning from mechanical ventilation

A
  • underlying reason for intubation resolved or improved
  • vital signs stable
  • blood gas acceptable
  • spontaneous effort (minimal sedation)
30
Q

What are some general steps for weaning?

A
  • Decrease O2 by 2 – 5% (to 40 - 50%)
  • Decrease PEEP 1 -2 CmH2O (to 3 – 5 cmH2O)
  • Decrease PIP 1 – 2 CmH2O (to 15 – 20)
  • Decrease rate 1 – 5 (to rate of 10 - 20)
  • Extubate to CPAP, HFNC or O2 as required
31
Q

What setting is commonly used for the pediatric population?

A
  • Volume control because they often have cuffed ETT
  • Need to consider volume loss due to circuit compliance
    • very important because of small Vt
  • set volume may need to be increased to compensate for lost volume if vent doesn’t automatically compensate
32
Q

What is the formula for volume loss?

to be used in ventilators that do not compensate

A

vol lost= driving pressure X TCF

driving pressure=PIP=PEEP

33
Q

What is the formula for Vt?

A

Vt= flow in L/sec X I-time

34
Q

What are hazards of mechanical ventilation?

A
  • Oxygen toxicity
  • Retinopathy of Prematurity (ROP)

-American Academy of Pediatrics recommends PaO2 < 80 mmHg

  • Bronchopulmonary Dysplasia (BPD)
  • Barotrauma
  • Decreased CO
  • Intraventricular hemorrhage (IVH)
  • Gastric distention (Use NG tube)
  • Infection
  • Complications of endotracheal intubation
35
Q

What is MAP?

A
  • Average pressure exerted on the airway and lungs from the beginning of inspiration until the beginning of next inspiration
    • a powerful influence on oxygenation
  • high levels (above 12 cmH2O) can lead to decreased cardiac output, pulmonary hypoperfusion and barotrauma
36
Q

How is a capillary blood gas performed?

A
  • Area is warmed to 42 degrees max to “arterilize” the blood
  • alcohol size
  • lancet puncture 2mm deep
  • collect a sample- do not squeeze site
  • fill tube quickly to minimize air exposure
  • outside of heel is preferred to avoided nerve damage
37
Q

What sites are used for an ABG in infants?

A
  • radial
  • temporal
  • pedal
  • umbilical in neonates
  • avoid brachial and femoral if possible
38
Q

What is transcutaneous blood gas monitoring?

A
  • O2 and CO2 diffused through the skin and can be measure to correlate with ABG
  • provides continuous monitoring
  • electrode warmed to 44 degrees to cause local vasodilation for more “arterialized” results
39
Q

ETT size by age

A
  • Full term: 3.5-4
  • 1 yr.: 4.5
  • 4 yr.:5.0
  • 8 yr.: 6.0
  • 12 yr.: 7.0
  • Over 1yr. age/4+4+ ETT ID
40
Q

What is HFPPV?

A
  • High frequency positive pressure ventilation
  • freq: 60-149
41
Q

What are indications for HFV? High frequency ventilation

A
  • Conventional ventilation inadequate
    • lung hypoplasia, PPHN, RDS, MAS
    • Maxed PIP, cant increase Vt etc
  • Multiple or recurrent pneumothoraces
  • persistent Leak!
  • upper airway surgery or special procedure laryngoscopy
42
Q

What changes do I make on HFO to adjust a PaCO2?

A
  • increase amplitude to decrease CO2
  • decrease frequency to decrease PaCO2
43
Q

What pressures are used for suctioning for neonates, peds, and adults?

A
  • Neonates: -60- -80 mmHg
  • Peds: -80- -100mmHg
  • Adults: -100- - 120 mmHg
44
Q

Indications of iNO

A
  • Hypoxemic respiratory failure
  • PPHN (persistent pulmonary HTN of the newborn)
  • CDH (congenital diaphragmatic hernia)
  • OI (Oxygenation index) >25
45
Q

What is the dosing of iNO? and how is it administered? what is the benefit of using NO versus other vasodilators

A
  • 20 ppm (can range from 10-80)
  • Administered continuously via vent circuit, nasal cannula, or Ambu bag
  • it is a selective vasodilator so it does not cause systemic hypotension
46
Q

What are some adverse effects of iNO?

A
  • NO2
    • pulmonary edema
    • lung tissue injury
  • rebound pulmonary hypertension and hypoxia with withdrawal
  • increase of methemoglobin levels
47
Q

What is the process of weaning iNO?

A
  • wean dose by half as tolerated
    • 20ppm→10→5→2ppm
    • FiO2 <= to .40 and PEEP <= 5 cmH2O
  • If the above are met and pt stable
    • increase FiO2 by .20
    • discontinue iNO
48
Q

How do we assess a patient on HFV?

A
  • Evaluate change by the chest wiggle
  • decrease in chest wall vibration or increased PaCO@ and decreased PaO2 could be
    • decreased lung compliance (decreases wiggle)
    • pneumothorax
49
Q

What are the indications of ECMO?

A
  • refractor respiratory failure
  • cardiac failure
50
Q

What is the difference between veno-venous ECMO and Veno-arterial ECMO?

A
  • VV
    • supports oxygenation and ventilation
    • Does NOT support cardiac output
    • double-lumen catheter in RA drains and replaces blood
  • VA
    • oxygenates blood and supports cardiac function and output
    • Blood removed from RA via internal jugular
    • returned to aortic arch via R carotid artery
51
Q

What do we do with the ventilator while a patient is on ECMO?

A
  • patient remains intubated and ventilated
    • reduced rate
    • reduced pressure
    • reduced FiO2
    • still supply PEEP
52
Q

What are possible complications of ECMO?

A
  • Emboli (anti-coagulants to help prevent)
  • intraventricular hemorrhage (IVH) bleeding
  • anemia, leukopenia, thrombocytopenia
    • caused by membrane oxygenator
  • infection
  • mechanical complications
53
Q

What are advantages of using TCM?

A
  • Non-invasive
  • Can detect hyperoxia
  • displays TcPo2 and TcPCO2 continuosly
    • can detect changes in patient status fast
    • way to monitor ventilation and oxygenation
54
Q

How can oximetry be used to assess pulmonary hypertension?

A
  • uses 2 probes. one placed pre-ductally and one post
  • greater than 5-10% difference in SaO2 (post and pre-ductal) is significant for PDA
  • indicated pulmonary HTN is present
  • ductus arteriosus is not closed between the aorta and pulmonary artery
55
Q

What is time-based capnography?

A
  • Exhaled CO2 partial pressure measure
  • non-invasive continuous trending of CO2
  • trends go together but are not the same. They trend
  • PECO2 normally 1-5 mmHg lower than PaO2
56
Q

What is the narrowest portion of a neonate airway vs. an adult airway?

A
  • Neonate: cricoid cartilage
  • Adult: vocal cords

Resp S21 (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions