Paediatrics Flashcards
What is the most cephalad intervertebral space @ which a spinal can be sited in a neonate where the risk of damage to the SC is minimal?
L3-4. 3rd foetal month the SC extends length of vertebral canal. Newborn/neonate: cord terminates @ L3. Adult: cord terminates @ L1-2 space.
Whats the TNZ in a neonate in deg c?
32-34 naked, 24-27degC clothed. TNZ= ambient temp range over which maintenance of core temp requires minimal energy expenditure. Neonate is a child in the first 28 days of life. Under 3/12 children can’t shiver. premiering (30wks gestation) has TNZ 34-35deg naked & 28-30 deg clothed. Adult TNZ is 27-37deg C.
what is the dose for defibrillator in paeds?
4J/kg
dose for Adr in paeds arrest?
10microg/kg
dose for atropine in paeds arrest?
20microg/kg
dose for fluid in paeds arrest?
20mL/kg
What’s the ETT size <1kg?
2.5
ETT size 1-3kg?
3
ETT size 3.5kg?
3.5
ETT size 10kg 1yo?
4
size of an ETT >1yo?
age/4 + 4
main cause of arrest in paeds?
hypoxia from airway obstruction
what’s the CPR ratio for infants & children?
15:2
dose of amiodarone for paeds arrest?
5mg/kg, after 3rd shock
Is paracetamol dosing based on actual or ideal body weight? What’s the dosing in <32 wks? <1/12? >1/12 (and loading)? When should loading not be given?
ideal, 10kg/kg (BUT 8-hourly so max 30mg/kg/24hrs), 10mg/kg (max 40mg/kg/24hrs), 15mg/kg (max 60mg/kg/24hrs), 20mg/kg loading dose >1/12 BUT the total 24hr dosing must not be exceeded. Don’t do a loading dose if the pt has received a paracetamol-containing product within the preceding 24hrs.
What’s a newborn vs neonate vs infant?
First mins to hrs of birth vs within first 28/7 of birth vs combined neonatal period up to 12/12 of life
When should paediatric vs newborn ALS techniques be used?
Use paeds techniques for any arrest beyond the first hours of birth up particularly if known cardiac etiology to arrest
At what temp should non-asphyxiated newborns of all gestations be maintained? Other considerations?
36.5-37.5. Dried, warm (skin to skin)
At what temp should infants at risk of, or who develop, hypoxic ischaemic encephalopathy be maintained?
normothermia, initiate induced hypothermia (& have admitted to NICU) if HIE confirmed
At what temp should infants at risk of, or who develop, hypoxic ischaemic encephalopathy be maintained?
normothermia, initiate induced hypothermia (& have admitted to NICU) if HIE confirmed
For term or late preterm infants >=34/40 deemed not to require immediate resus, what does ANZCOR suggest wrt cord clamping? How about preterm if don’t need immediate resus? And if need immediate resus?
Late (>=60 secs) vs immediate if >=34/40 but if <34/40, defer cord clamping at least 30 seconds. Infants who need immediate resus @ any gestation, no sufficient evidence to make recommendation wrt cord management
What are some equipment considerations for neonatal resus?
Practitioners should all be aware of assembly processes & alert to any errors- if unexplained hypoxia, change the gas supply & circuits or remove pts from ventilators by using self-inflating bag w RA- consider analysis of delivered gases & use an oxygen analyser in these situations.
What is the most sensitive indicator of resuscitation efficacy of the newborn?
Prompt increase in HR
What should the initial & subsequent assessment of the newborn address?
Tone, HR, breathing.. then subsequent assessment: HR, breathing, tone & oxygenation
What to do if the infant has low tone, isn’t breathing or can’t maintain HR >100bpm?
gentle positive pressure ventilation
What to do if the infant has low tone, isn’t breathing or can’t maintain HR >100bpm?
gentle positive pressure ventilation
What should be done if the newborn has regular respiratory effort but recession/retraction of lower ribs/sternum or persistent expiratory grunting?
gentle CPAP
Why pulse ox on R) hand in newborn?
know it’s pre-ductal
What goal HR should newborns achieve?
100 within 2 mins of birth
What interventions should occur if a newborns HR is <100bpm?
CPAP or positive pressure ventilation