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Neonatal/Pediatric ER (Allen) Flashcards

1
Q

Neonate

A
  • Birth through 2-3 weeks
  • Able to walk
  • Capable of spontaneous urination and defecation
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2
Q

Pediatric

A
  • 2-3 weeks of age until 4-6 months of age
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3
Q

Comprehensive neonate history

A
  • Duration of illness
  • CS noted by owner
  • Number affected in litter
  • Treatments provided
  • Dam history
  • Colostrum ingestion
  • Birth weight
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4
Q

Colostrum

A
  • Endotheliochorial placenta
    • limits offspring antibodies
      • up to 25% kittens
      • maybe 5-10% dogs
  • Max absorption at 8 hours
  • Measuring
    • compare ALP and GGT
    • measure IgG
  • Can supplement
    • PO
    • SC
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5
Q

Birth Weights

A
  • Kittens
    • average 100g
    • 1 lb/month
  • Puppies
    • toy breeds
      • 120 g
    • medium breeds
      • 250 g
    • Large breed
      • 490 g
    • Giant breed
      • 625 g
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6
Q

Expected weight gain

A
  • Kittens
    • 7-10 grams/day
    • may lose some weight in first 24 hrs
    • should double by 7-10 d
  • Puppies
    • 1 g/lb of expected adult weight
    • may lose some weight in first 24 hrs
    • should double by 7-10 days
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7
Q

Records

A
  • Identify females/males
  • Attach paper collars with neonate number
  • Have individual records on each patient
  • Gram scale to monitor daily weight/trends
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8
Q

Normal puppy vitals

1 week old

A
  • T: 99.5
  • P: 180-220 beats/min
  • RR: 32 breaths/min
  • mm: hyperemic
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9
Q

Thermoregulation

A
  • Poor
  • limited ability to shiver
  • limited ability to vasoconstrict
  • larger surface area to body mass
  • little body fat
  • poor blood flow to extremities
  • high water compensation
  • unable to pant
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10
Q

Normal neonate temp

A
  • week 1
    • rectal temp: 96-97
    • environmental temp: 86-90
  • week 2-3
    • 97-100
    • environmental temp: 80-85
  • week 4
    • rectal temp: 99-101
    • environmental temp: 70-75
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11
Q

Complications of hypothermia

A
  • Depressed respirations
  • bradycardia
  • ileus
    • don’t feed until normothermic
  • coma
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12
Q

Cardiovascular system

Neonate vs adult

A
  • Lower than adult
    • blood pressure
    • stroke volume
    • peripheral vascular resistance
  • Higher than adult
    • heart rate
    • cardiac output
    • plasma volume
    • central venous pressure
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13
Q

Cardiovascular system

neonate

A
  • Immature autonomic nervous system
    • lack of baroreceptor control
  • Under-developed control on myocardial contractility
  • No sinus arrhythmia
  • Heart rate
    • week 1: 200-220 bpm
  • Bradycardia and hypotension
    • often due to hypoxemia
  • Murmurs common during first week
    • closure DA
    • if persistent - investigate
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14
Q

Respiratory system

A
  • Fetus: blood-gas exchange across placenta
  • Fetal cortisol => surfactant
  • Umbilical cord separation
    • hypoxia
    • inc vascular resistance
    • Dyspnea
      • reflex contraction of thoracic muscles
    • negative airway pressure
      • breathe
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15
Q

Resp system normals

A
  • 15-20 breaths/min in newborns
  • 20-30 breaths/min
  • inc resp rate in neonates
    • normalizes in pediatric period
    • be mindful of resp dep drugs
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16
Q

Gi system

A
  • Oral cavity
    • cleft palate
    • cleft lip
    • teeth
  • abdoment soft and compliant
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17
Q

Urogenital

A
  • urogenital openings
    • atresia ani
  • check for patency of urinary system
    • stimulation
  • nephrogenesis first 2 weeks
    • GFR: adult level at 8 weeks
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18
Q

Umbilical cord

A
  • Clean and dry
  • no redness, swelling, d/c
  • falls off in 2-3 days
  • Omphalitis
    • infection of umbilical cord
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19
Q

Sensory organs

NOT TEST QUESTION

A
  • Eyelids separate 5-14 days
  • corneal edema for 2-3 weeks
  • menace and PLRs 10-21 days
  • Fundic exam unreliable during neonate period
  • ear canals open 6-14 days
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20
Q

Neuro system

A
  • Skull palpation
    • assess for closure of bregmatic fontanelle
  • Righting reflex
  • Rooting reflex
  • Suckle reflex
  • Flexor dominance 0-4 days
  • Extensor dominance 5-21 days
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21
Q

Normal neonate

A
  • Strong suckle
  • Cry in response to
    • pain
    • hunger
    • cold
    • loss of maternal contact
  • Sleep after nursing
  • Hyperemeic mucus membranes
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22
Q

Fluid requirements

A
  • Higher in neonates
    • 80-100 ml/kg/day
  • reasons
    • higher % total body water
    • greater surface area to body weight ratio
    • higher metabolic rate
    • decreased renal concentrating ability
    • decreased body fat
23
Q

Assessing hydration status

A
  • Weight
  • Urine color
    • should look like water
  • Mucus membranes
    • Severe dehydration (10-15%)
      • pale mm
      • slow CRT in absence of anemia
  • Thoracic rads
  • Hct, total solids
    • 30 normal, I think
24
Q

Routes of fluid admin

A
  • PO
  • IV
    • 20-40 ml/kg shock volume
    • LRS
  • IO: intraosseous
  • SC: subcutaneous
25
Q

Intraosseous catheter

locations

A
  • Intertrochanteric fossa
  • Tibial crest
  • Proximal humerus
26
Q

Cysto

A

is possible in neonates

27
Q

Hematopoietic system

28
Q

Urinary system differences

A
  • Over first month
    • GFR inc 7x
    • RBF inc 4x
  • BUN higher at birth
    • decreases between 2wks-3 months
  • USG: 1.006-1.017
  • 50% neonates have glucosuria
29
Q

Biochemical differences

A
  • Sodium and Chloride slightly lower
  • Potassium
    • low at 2-4 weeks
    • peaks 6-8 weeks
  • Bilirubin slightly higher
  • ALP and GGT up to 20 x higher
  • Phosphorus higher
30
Q

Coagluations system

A
  • Lower concentration clotting factors and antithrombin
  • Prothrombin time (PT) about 1.3x adult
  • Partial thromboplastin time (aPTT) about 1.8x adult
  • Platelets similar to adult
31
Q

Imaging rads

A
  • Thorax
    • thymus on left
    • heart bigger
    • interstitial lung pattern
  • Abdomen
    • liver appears larger
    • loss of detail

*normally useless in babies

32
Q

PRRA can cause

A

megaesophagus (I think)

33
Q

Pharmacological considerations

A
  • lower
    • body fat
    • total protein
  • Immature kidneys and liver
  • Liver complicated as neonates
    • if need activation, expect less circulating drug conc
    • if need activations for excretion, expect higher circulating concentrations
  • Permeable GI tract first 72 hours
34
Q

Pharmacological considerations

antibiotics

A
  • BBB not fully developed
  • Antibiotics
    • avoid aminoglycocides
      • unable to monitor
    • no chloramphenical
      • BM suppression
    • no sulfonamides
      • BM suppression
    • no tetracyclines
      • skeletal/dentition abnormalities
    • avoid fluoroquinolones
      • cartilage damange
35
Q

ok antibiotics for neonates

A
  • b-lactams
  • metronidazole
36
Q

Analgesics and anesthetics

A
  • Opioids
    • lower doses in younger patients
      • fentanyl ideal - Naloxone
  • Local anesthetics
    • lidocaine
      • max dose neonatal kittens: 3 mg/kg
      • max dose puppies: 6mg/kg
    • EMLA cream
  • no NSAIDS
37
Q

Common emergencies

A
  1. Hypothermia
  2. Hypovolemia and dehydration
  3. Hypoglycemia
  4. Hypoxemia
  5. Sepsis
  6. Trauma
    • ESP TBI
38
Q

Hypovolemia and dehydration

A
  • Poor perfusion and decreased oxygen delivery to tissues
  • more susceptible to volume loss
    • poor compensatory mechanisms
    • ANS not mature until 8 weeks
  • Causes
    • diarrhea
    • vomiting
    • decrearsed intake
39
Q

Hypobolemia and dehydration

Treatment

A
  • If hypovolemic IV or IO access
    • 20-40 ml/kg warm IV fluid bolus
    • re-exam patient
  • If dehydrated, IV, IO, PO
    • depends on circumstances
  • Daily fluid requirement
    • 80-100 ml/kg/day
  • Weigh q6-12h
40
Q

Hypoglycemia

A
  • Neonates more susceptible
    • inefficient hepatic gluconeogenesis
    • decreased hepatic glycogen stores
    • glucosuria (50%
    • inefficient counter regulatory hormones
      • epi
      • growth hormone
      • cortisol
      • glucagon
    • CNS energy substrate
    • Neonatal myocardium reliant

*Dextrose: 1 ml/kg 50% (dilued 1:3) IV then CRI 2.5-5%

41
Q

Hypoxemia

Ddx

A
  • At birth
    • pulmonary hypertension
    • decrearsed surfactant
    • aspiration of meconium or periparturient fluid
    • congenital defect
  • Days to weeks
    • aspiration
    • infection
    • congenital defects
42
Q

Hypoxemia TX

A
  • Oxygen
  • IV antibiotics if pneumonia
    • potentiated beta-lactams
  • Nutritional support
  • Heat support
43
Q

Sepsis

A
  • Sources of infection
    • Oomphalitis
    • Tail docking
    • Pneumonia
    • GI infections
  • Etiologic agents
    • Staphylococcus
    • Streptococcus
    • E. Coli
    • Pseudomonas

*lack of colostrum increases risk

44
Q

Sepsis

Treatment

A
  • Source of control
  • IV fluids
  • Dextrose
  • Antibiotics IV
  • Nutritional support
  • Heat support
  • +/- inotropes
45
Q

Traumatic brain injury

A
  • NO swinging during resuscitation
    • subdural hematoma
  • Trauma
  • Treatment goals
    • improve oxygen delivery
    • decrease ICP
    • maximize CPP
46
Q

Parasitemia

A
  • 2-4 weeks of age
  • Type
    • roundworms
    • hookworms
    • coccidia
    • giardia
    • fleas
    • ticks
    • mycoplasma (cats)
47
Q

Parasitemia

Signs

Diagnostics

TX

A
  • Signs
    • pale mm
    • tachycardia
    • lethargy
    • hypothermia
    • visual infestation
  • DX
    • PCV/TX
    • NOVA
    • blood smear
  • Treatment
    • Blood transfusions (if severe)
    • Deworm
    • Re-hydrate
    • No ‘safe’ flea treatment
48
Q

BOARD QUESTION

A

mycoplasma haemophilus

  • common in kittens
  • epicellular
  • fresh blood smear
49
Q

Neonatal resuscitation station

A
  1. Trained staff
  2. Sterile drapes
  3. Bulb or tube suction
  4. Small face masks
  5. Small ET tubes
  6. Reversal agents
  7. Hemostats
  8. Suture and dilute betadine
  9. Warm area for recovery
50
Q

Neonatal resuscitation

A
  • flow-by oxygen
  • DV position
  • extended head
  • stim of respiration
    • GV26
    • doxopram: 1 drop sublingual
51
Q

Neonatal Isoerythrolysis (NI)

A
  • Immune mediated destruction of kitten’s erythrocytes by queen’s antibodies
  • Kittens with type A or AB blood nurse from t ype B queen
  • Queen passes anti-A IgG antibodies in colostrum
52
Q

NI CS

A
  • Dead
  • stop nursing
  • weak
  • hemoglobinuria
  • jaundice
  • anemia
  • tachycardia
  • tachypnea
  • tail necrosis
53
Q

NI TX

A
  • Transfusion
    • give mom’s blood first 3 days
      • must wash the red cells
    • after 3 days give type A blood
54
Q

Wrap up

Know these

A
  1. Normal physical examination findings
  2. Importance of colostrum
  3. Physiological differences
  4. Packed cell volume difference
  5. Fluid requirements
  6. Common ER

ECC (18 decks)

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