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Apex Flashcards > neonatal a&p > Flashcards

neonatal a&p Flashcards

1
Q

newborn BP, HR, RR

A

BP 70/40
HR 140
RR 40-60

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2
Q

1 year BP, HR, RR

A

BP 95/60
HR 120
RR 40

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3
Q

3 year BP, HR, RR

A

BP 100/65
HR 100
RR 30

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4
Q

12 year BP, HR, RR

A

BP 110/70
HR 80
RR 20

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5
Q

in the newborn, HoTN is defined as SBP <

A

60mmHg

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6
Q

explain why neonate RR is higher

A

they have twice the O2 consumption and CO2 production than adults (infants 6mL/kg/min, adults 3mL/kg/min). its metabolically more efficient to increase RR rather than Vt so thats why RR is increased but Vt is 6mL/kg

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7
Q

HoTN in <1yr is defined as

A

<70mmHg

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8
Q

HoTN in patients older than 1 year

A

(70 + (childs age in years x 2))

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9
Q

in the setting of hypovolemia and bradycardia, which drug is preferred

A

epinephrine since it augments contractility (if only little bit)

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10
Q

why does the child become less dependent on HR

A

as SVR rises, LV creates more contractile filaments and frank starling starts to be a conversation. therefore the patient becomes less dependent on HR over time to support CO

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11
Q

infant vocal cord position

A

C1-2

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12
Q

describe the infant epiglottis

A

long and stiff

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13
Q

vocal cord position: adult versus infant

A

adult: perpendicular to trachea
infant: anterior slant

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14
Q

alveolar ventilation: adult versus infant

A

adult: 60mL/kg/min
infant: 130mL/kg/min

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15
Q

infants have a ___________ alveolar ventilation relative to FRC size

A

increased

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16
Q

do adults and neonates have the same amount of dead space on a per weight basis

A

yes

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17
Q

what type of muscle fibers do infants have in their diaphragm

A

more type 2 (fast twitch) muscle fibers and less type 1 (slow twitch) muscle fibers (25% type 1 as compared to 55% in adults)

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18
Q

children less than ______ are at risk for apnea and should be admitted for 24h post surgery

A

60w PCA

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19
Q

what can you do to be prophylactic about postoperative apnea

A

caffeine 10mg/kg IV

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20
Q

describe lung compliance in the newborn

A

lower lung compliance due to fewer alveoli

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21
Q

describe chest wall compliance in newborn

A

higher compliance due to cartilaginous (flimsy) ribcage

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22
Q

describe the issue with closing capacity in the newborn

A

overlaps with Vt during normal breathing

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23
Q

lung capacities that are decreased relative to adults

A

FRC, VC, TLC

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24
Q

lung capacities that are increased relative to adults

A

closing capacity, RV

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25
Q

mother at term pH, PaO2, PaCO2

A

pH 7.4
PaO2 90
PaCO2 30

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26
Q

umbilical vein: placenta to fetus pH, PaO2, PaCO2

A

pH 7.35
PaO2 30
PaCO2 40

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27
Q

umbilical artery: fetus to placenta pH, PaO2, PaCO2

A

pH 7.3
PaO2 20
PaCO2 50

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28
Q

newborn at time after delivery pH, PaO2, PaCO2:
10 minutes

A

pH 7.2
PaO2 50
PaCO2 50

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29
Q

newborn at time after delivery pH, PaO2, PaCO2: 1 hour

A

pH 7.35
PaO2 60
PaCO2 30

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30
Q

newborn at time after delivery pH, PaO2, PaCO2: 24h

A

pH 7.35
PaO2 70
PaCO2 30

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31
Q

during the first hour of extrauterine life, what does the newborn do and why (think respiratory)

A

hyperventilates. likely due to poor buffering capacity and compensation for non volatile acids in the blood.

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32
Q

when does respiratory control mature and what is the response to hypoxia before versus after this time

A

42-44w PCA
<44w, hypoxia depresses ventilation
>44w, hypoxia stimulates ventilation

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33
Q

life span of fetal HGB

A

70-90 days

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34
Q

HgbF P50

A

19mmHg (adult 26.5mmHg)

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35
Q

HgbA begins to replace HgbF at ____________ and is complete by _____________

A

2 months and is complete by 6 months

36
Q

why does the HgbF left shift benefit fetus

A

creates o2 partial pressure gradient that facilitates passage from mother to fetus

37
Q

during which months can you expect physiologic anemia

A

months 2-3 (~hgb 10)- remember shift from HgbF to HgbA is starting

38
Q

transfusion trigger for children less than 4 months with severe cardiopulmonary disease

A

<13mg/dL

39
Q

transfusion trigger for children less than 4 months with moderate cardiopulmonary disease

A

<10mg/dL

40
Q

PRBC dose for kid <4mo of age

A

10-15mL/kg
(10mL/kg will increase HGB by 1-2g/dL)

41
Q

for children with no issues and less than 4 months, transfuse when?

A

<6
6-10, go by sx

42
Q

3 indications for FFP transfusion

A
  1. emergency reversal of warfarin
  2. correction of coagulopathic bleeding with increased PT or PTT
  3. correction of coagulopathic bleeding if >1 BV has been replaced and coagulation studies are not easily obtained
43
Q

FFP dose

A

10-20mL/kg

44
Q

when is platelet transfusion recommended

A

maintain platelet count above 50,000

45
Q

platelet dose if obtained from apharesis

A

5mL/kg

46
Q

platelet dose if pooled platelet concentrate

A

1pack/10kg

47
Q

one pooled platelet concentrate will increase serum platelets by

A

50 x 10^9

48
Q

massive transfusion is associated with (5, think electrolytes and pH)

A

alkalosis (due to citrate metabolism to bicarb in the liver)
hypothermia
hyperglycemia (dextrose additive in stored blood)
hypocalcemia (binding of calcium via citrate)
hyperkalemia (administration of older blood)

49
Q

newborn normal Hgb and Hct

A

Hgb 14-20
Hct 45-65

50
Q

3 months normal Hgb and Hct

A

Hgb 10-14
Hct 31-41

51
Q

6-12 months normal Hgb and Hct

A

hgb 11-15
hct 33-42

52
Q

adult female normal Hgb and Hct

A

12-16
37-47

53
Q

adult male normal Hgb and Hct

A

14-18
42-50

54
Q

premature neonate EBV

A

90-100

55
Q

term neonate EBV

A

80-90

56
Q

infant EBV

A

75-80

57
Q

1 year EBV

A

70-75

58
Q

max allowable blood loss equation

A

EBV* (starting HCT- target HCT)/starting HCT

59
Q

compared to adult, the newborn kidney has decreased

A

perfusion pressure, GFR, and dilution/concentration ability

60
Q

when does GFR mature

A

improves substantially over first few weeks of life but does not mature until 8-24 months of age

61
Q

when does renal tubular function mature

A

improves after birth but does not have full concentrating ability until ~2 years

62
Q

premature TBW %, ECF %, ICF %

A

TBW 85%
ECF 60%
ICF 25%

63
Q

neonate TBW %, ECF %, ICF %

A

TBW 75
ECF 40
ICF 35

64
Q

child and adult TBW %, ECF %, ICF %

A

TBW 60
ECF 20
ICF 40

65
Q

signs of dehydration

A

sunken anterior fontanel
weight loss (10% reduction in first week is normal)
irritability or lethargy
dry mucous membranes
absence of tears
decreased skin turgor
increased Hct (concentration)

66
Q

hourly maintenance 4:2:1 rule

A

0-10kg–>4mL/kg/h
10-20kg–> add 2mL/kg/h to previous total
>20kg–> add 1mL/kg/h to previous total

67
Q

third space loss calculation: minimal surgical trauma

A

3-4mL/kg/h

68
Q

third space loss calculation: moderate surgical trauma

A

5-6mL/kg/h

69
Q

third space loss calculation: major surgical trauma

A

7-10mL/kg/h

70
Q

ratio of replacement for:
crystalloid
colloid
blood

A

crystalloid 3:1
colloid 1:1
blood 1:1

71
Q

use of glucose containing fluids should be reserved for the following populations

A

premature
less than 48h
small GA
newborns of diabetic mothers
children with DM who received insulin the day of surgery
children who receive glucose based parenteral nutrition

72
Q

less than 72h old, signs of hypoglycemia can manifest if BG is <

A

30-40mg/dL

73
Q

older than 72h old, signs of hypoglycemia can manifest if BG is <

A

40mg/dL

74
Q

tx of hypoglycemia

A

10% dextrose 2mL/kg
if seizures are present, dose is doubled
after bolus, D10 infusion at 8mL/kg/min is titrated to maintain serum glucose >40mg/dL

75
Q

newborn CO

A

200mL/kg/min

76
Q

water soluble drugs and neonate dosage

A

neonates have higher TBW so need higher dose of water soluble drugs

77
Q

before _____ months, infants have less albumin and alpha 1 glycoprotein

A

6

78
Q

lipid soluble drugs and infant dosage

A

infants have lower percentage of fat and muscle mass and therefore lipid soluble drugs take longer to cleart

79
Q

drug biotransformation is under developed in the first

A

month of life

80
Q

hepatic values are not reached until how old?

A

one year

81
Q

what do infants lack for bilirubin conjugation

A

glucoronyl transferase

82
Q

when does MAC peak at its highest level

A

2-3 months

83
Q

IM succ dose neonates versus children

A

neonates 5mg/kg
children 4mg/kg

84
Q

IM roc dose children <1 year and > 1 year

A

<1 year 1mg/kg
>1 year 1.8mg/kg
onset IM 3-4 min

85
Q

what conditions contribute to failure from fetal to adult circulation in the newborn?

A

acidosis, hypothermia

86
Q

citrate most often occurs in neonates and infants following the administration of what

A

FFP

Apex Flashcards (71 decks)

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