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Bristol FRCA Crammer > Paediatrics > Flashcards

Paediatrics Flashcards

1
Q

Anatomical differences head & neck

x6

A
  1. Large head
    - prominent occiput
    - Short Neck
  2. Large Tongue
  3. Small Mandible
  4. High Larynx (C2-3)
  5. Large floppy epiglottis
  6. Cricoid narrow ring
  7. Small mouth
  8. Short trachea
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2
Q

Airway Problems Occur d/t anatomical differences

A
  1. Large head -> Obstruct Airway easier
    - prominent occiput
    - Short Neck
  2. Large Tongue - Easily obstruct Airway
  3. Small Mandible
  4. High Larynx
  5. Large floppy epiglottis -> Difficult laryngoscopy with traditional laryngoscopes
  6. Cricoid narrow ring -> Narrow sizes for tubes
  7. Small mouth -> difficult inserting equiprment
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3
Q

Describe how problems overcome

A
  1. Large head -> Obstruct Airway easier
    - prominent occiput
    - Short Neck
  2. Large Tongue
  3. Small Mandible
  4. High Larynx
  5. Large floppy epiglottis
  6. Cricoid narrow ring -> Narrow sizes for tubes -> size down tube or uncuffed
  7. Small mouth
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4
Q

Describe how problems overcome

Large Head

A

The larynx is high and anterior, at the level of C3 - C4.

The epiglottis is long, stiff and U-shaped. It flops posteriorly.

The ‘sniffing the morning air’ position will not help bag mask ventilation or to visualise the glottis. The head needs to be in a neutral position.

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5
Q

Describe how problems overcome

Cricoid narrow ring

A

The airway is narrowest at the level of the cricoid cartilage.

Here, pseudo-stratified, ciliated epithelium is loosely bound to the underlying areolar tissue. Trauma to the airway easily results in oedema. One millimetre of oedema can narrow a baby’s airway by 60% (Resistance µ 1/radius). It is suggested that a leak be present around the endotracheal tube to prevent trauma resulting in subglottic oedema and subsequent post-extubation stridor

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6
Q

Describe how problems overcome

Trachea

A

The trachea is 4-5 cm long and funnel shaped. An endotracheal tube must be inserted to the correct length to sit at least 1cm above the carina and be taped securely so as to prevent tube dislodgement with head movement or an endobronchial intubation.

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7
Q

Describe how problems overcome

Epiglottis

A

Large floppy epiglottis -> The epiglottis is long, stiff and U-shaped. It flops posteriorly.

Difficult laryngoscopy with traditional laryngoscopes

Straight blades used like Robertshaw & miller

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8
Q

Anatomical differences

  • Lower respiratory
A

Carinal Angle

Fewer alveoli

Horizontal soft ribs

pleural pressure atmospheric

fatigable Diaphragm
- dont have bucket handle

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9
Q

Fewer alveoli

A

CC>FRC

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10
Q

Ideal Paeds breathing systems

A
  1. Easy to use
  2. Light
  3. Low Dead space
  4. Low Resistance
  5. Heat moisture conserved
  6. Can scavenge
  7. IPPV or SV
  8. Economical
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11
Q

What are anatomical features important to consider when performing block safely

A
  1. Spinal cord ends at L3/L4
    - vs L1 / L2 in adults
  2. Dural sac s3/4
  3. Sacral vertebrae cartilaginous @ birth
  4. Failed fusion posterior Arch S5 (4/3)
  5. Sacrococcygeal membrane ends at S5
  6. Equilateral triangle - PSI joints
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12
Q

What are the contraindications

A

Spina bifida
lumbar sacral abnormality

Haematological dysfunction

Parental / Child refusal

Caution sepsis

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13
Q

What are the problems complications

A

NAP 3 no incidence of perm harm/death >18000 caudals

LA toxicity (albumin less / less a2 alphaglyco)
20% Intralipids 1.5mls.kg

Dural Puncture (Sac extends to S4)

Failure, Sepsis, Bleeding

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14
Q

What constraints limit the effectiveness of block + how can be overcome

A

spread of block predictability -armitage formula

need to add info here

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15
Q

Caudal Armitage formula

A

0.5ml/kg - Sacro-lumbar

1ml/kg - Upper Abdominal

  1. 2 ml/kg - Mid Thoracic
  2. 25 chirocaine

Adjuncts

Ketamine 0.5ml/kg

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16
Q

What time defines prem

A

<37 weeks

13% uk births

17
Q

Prematurity
Risk factors

How can be minimised

A

Apnoea

Ventilation
lack ventilation

PDA

Hypoglycaemia
- caution with starvation

Sepsis

18
Q

Respiratory physiology

O2 / volumes

A

Oxygen demand 7ml/kg

Low O2 store
-rel low frc
CC>FRC until 5 years

TV 6mls/kkg

Apneoa - > 20 seconds

  1. Tongue causes obstruction
  2. Loss biphasic response - stimulate

TV 6 mls /kg

MV infant 200ml/kg
adult 100ml/kg

Blunted increase RR CO2 even less wit hypoxia

19
Q

Resp physiology ventilation

A

Small dimaeter increases resitance to airflow

highly compliant lungs

Poorly supported surrounding structures

Chest well high compliant
- poorly maintained intrathoracic -ve pressure

20
Q

Apnoea

A

Apnoea

  • > 20 seconds
  • <20 seconds w/ physiology compromise
  • cyanosis / bradycardia

Increased risk with

PCA<45/40

Born <34/40

Previous Apnoea

Anaemia Hct <30%

Anaesthesia

21
Q

Safe to go home

A

Term/ heathy
>44/40

Ex-Prem >60/40

Otherwise need overnight stay
apnoea monitor
Pulse ox
Avoid clonidine

Caffeine not proven

22
Q

Foetal Circulation

A

Oxygenated blood comes in Umbilical vein

->

Ductus venousus

->

Right side heart

->

PFO

->

Left side

->

Brain

Returns SVC

Patent duct

23
Q

Foetal o2 sats

A

Umbilical vein 80%

IVC + UV 70

SVC 25%

RA 60%

Asc Ao 60%

Descending Ao 50%

24
Q

1st Breath

A

↓ RA pressure
-d.t
↓VR

1st breath opens lungs & ↓PVR

↑SVR - Cord clamp

Alters SVR/PVR ratio -> ↓blood flow PDA to Aorta

↑ pulmonary blood flow = ↑ LA pressure

LAP>RAP close PFO

Further ↓ PVR d/t

  • increase paO2
  • Increase pH
  • BK release
25
Q

PDA

A

Common in prems / ex prems

Predisposing factors

  • ↓O2
  • ↓pH
  • Pain
  • cold
  • stress
  • ↓Glycaemia
  • sepsis
  • catecholamine
26
Q

Prob w/ PDA

A 
L-R shunt=
LV Vol overload
- Heart failure
- pulmon oedema
- ventilator dependent
27
Q

Rx L-R Shunt PDA

A

Med
Indomethacin/
diuretics

surgical
Prem + Vent dependent

transcath closure
if can wait

28
Q

Surfactant

A

Respiratory distress

29
Q

Thermoregulation

A

Increase risk of hypothermia

  • large BSA
  • Limited ability deal with cold

Shivering -

  • Less SNS
  • less heat production until 6/12

Thin Skin
increased evap loss

Body fat
Very little
mobilisation brown fat

30
Q

Thermoreg

Rx

A

Cover head

Theatre temp

Warm theatre

31
Q

Renal

A

.

32
Q

A formula to calculate body weight

for children over the age of one year is:

A

weight in kg = (age in years + 4) × 2.

33
Q

Formula for blood volume calculation

A

Therefore, our 4-year-old girl has an estimated weight of 16 kg. The blood volume calculation is based on 80 ml/kg up to 2 years of age and 70 ml/kg thereafter. The injured girl therefore has an estimated blood volume of 1120 ml or approximately 1200 ml.

Bristol FRCA Crammer (2 decks)

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