Paeds Flashcards
Circulating volume of neonate vs adults
Neonate 90ml/kg
Adults 70ml/kg
Prems can be up to 110ml/kg
Total body water neonates vs adults
Neonates 75-80%
Adults 60-65%
Neonates proportionately more ECF than adults
Apgar score
5 domains all score 0-2 points max score 10
Appearance, pulse, grimace, activity/tone, resp
Should be done at 1, 5 and 10mins if initial two low
Metabolic derangement in pyloric stenosis
Hypochloraemic hypokalemic hyponatremic metabolic alkalosis
Which way face ett bevel in TOF surgery
Face bevel away from fistula
When do apnoeic periods continue until
60 weeks post conceptual age (highest risk until 44 weeks)
Spinal cord and dura level in neonates vs adults
Spinal cord neonates l3 vs adults l1
Dura s3 adults s1
Features of meningococcal sepsis
Non blanching rash CRT more than 2 Reduced conscious level Toxic moribund state Unusual skin colour Shock Leg pain
Management of meningococcal sepsis
Oxygen IV IO access Blood lactate and glucose Fluid bolus 20ml kg up to 60 IV antibiotic s ie ceftriaxone 50-80mg kg Consider intubation and ventilation Picu Vasopressors norad in warm shock adrenaline in cold shock
Specific investigations meningococcal septicaemia
Blood cultures
Lactate
CT
Coagulation
LP is controversial
Indications for intubation and ventilation in meningococcal septicaemia
Reduced conscious level
40ml kg consider and should be at 60
Increased ICP
Stabilisation prior to transfer
Physiological factors effecting gastric emptying
Increase gastric emptying
Large volume
Liquid
Sittin* position
Motulin gastrin
Reduce gastric emptying High fat chyme Duodenal food bolus Somatostatin Cck Lateral position
Pharmacological factors effecting gastric emptying
Drugs increasing gastric emptying include
Erythomycin
Dopamine antagonists ie metoclopramide
Neostigmine
Drugs reduced gastric emptying
Opiates
Atropine and glyc
Patient factors effecting gastric emptying
Increased gastric emptying
Hyperthyroid
Reduced Stress Anxiety Pain Pregnancy
Effects prolonged fasting in children
Unsettled child Parental anxiety Hypogylecema Ketoacidosis Hypotension PONV
Define cerebral palsy
Diverse group of neurological disorders resulting from brain injury or abnormalities antenatally or within first two years of life.
Result in varying degrees of motor sensory and intellectual impairment
Clinical effects CP effects on anaesthetics
CNS consent and capacity
Communication re pain
Epilepsy
Usual auditory impairment
GI effects CP bulbar palsy reflux
Resp effects cp secretions restrictive lung defects pulmonary hypertension
Msg fixed flex ion deformities, heat loss low sc fat, poor muscle contraction resulting in bleeding
Post op care cp
Good continuous analgesia
Physiotherapy
Active warming
CPAP
Challenges re post op pain management in CP
Communication difficulties
Opiate sensitive
Interaction other drugs
Scoliosis surgery aims
Cosmetic treatment of deformity
Prevention restrictive lung deficit
Correction of posture
Cobbs angle
Angle between the two most angles vertebrae
More than ten degrees abnormal
Operate more tha 40 degrees
Perioperative methods to reduce blood transfusion in scoliosis surgery
Treat anaemia Treat coagulopathy Hypotensive anaesthesia Surgical technique Tranexamic acid Cell salvage Minimise pressure on abdomen Monitor drains
Option OLV sociologist surgery
Doubt lumen tubes
Bronchial blocker
Endobronchial intubation
Univent tube
Neurophysiology in scoliosis surgery
Somatosensory evoked potentials- stimulus to posterior tibial never and picked up epidural or scalp electrode
Motor evoked potentials - transcranjal electrode stimulation of motor cortex and detected compound muscle action potentials
Intraoperative wake up test
Analgesia for scoliosis
Paracetamol Fentanyl Morphine LA by surgeons e Clonidine Ketamine
Steroid doses if on steroids
2mg/kg
Things to do if child on steroids or addisons
First on list
No starving more tha 6 hours.
Consider IV acc3ss and glucose
2mg/kg bolus then infusion
Extra Cade pituitary insufficient and those with DI as can end up with water intoxication
