Paeds Flashcards
Syndromes:
Apert
AD
cardiac / renal
“C’s”
premature closure of cranial sutures
midface hypoplasia
choanal atresia
cleft palate
C5/6 fusion
syndactyly
II due to megalocephaly/hypoplasia of white matter/corpsum collosum agenesis
Key
1. OSA 50% –> UAW –> routine maneouver
craig sims
craniosynostosis - usual surgery
Syndomes:
Beckwith-Wiedemann
Macroglossia
Visceromegaly - big heart etc
* Hypoglycaemia
Omphalocoele
Key
1. Glucose when fasting
Syndromes:
CHARGE
Colobama of eye
Heart defects
choAnal atresia
R - develop delay
G - GU abnor
E - ear abnor
Key
1. Cardiac defect
2. Poor resp reserve
Syndrome:
DiGeorge
1:4000 microdeletion 22q11.2 chromosome deletion
~ cardiac disease
Key
1. Micrognathia
2. Cleft palate
3.
Syndrome
Cri-du-Chat
C - C
Cat cry / cardiac defect
Severe II
Hypotonia
Key
1. Micrognathia
2. Abn larynx
3. Cardiac defect
Syndrome
Prader-Willi
Chr 15
PWC OOHH - cardiac/obesity/OSA/hypot/hypog
Hypotonia
Hypogonad
II
erratic
short
MO***
Key
1. OSA
2. Cardiac
3. Difficult PIVC
4. Difficult to fast
Syndrome
Treacher Collins Syndrome
1st 2nd branchial arches
AB C - b arches collins
Key
1. Very diff airway
2. Abnom funnel shape larynx
3. LMA effective
4. AW more diff with age - mandible does not grow
- ## require trache
Conditions associated with airway problems
Pierre Robin
Treacher Collins
Goldenhar
Micrognathia
Retrognathia
goldenhar - Congenital heart disease - asymmetry treacher collins
PRS - cleft palate, tongue immobile due to small mandible
AW mx - nasopharyngeal (suture - tricky if cleft palate), jaw thrust, LMA, prone/lateral (displace tongue)
Syndrome
Down’s
Commonest - 1.6/1000
3/3/3/3
CNS
Impaired development
Atlantoaxial instability
Epilepsy
CVS
Congential cardiac defects - AVSD/TOF
Eisenmenger’s syndrome
*Bradycardia (autonomic dys)
Resp
Recurrent RTI –> O2 + PT
hypoventilation
Endo
Obesity
Hypothyroidism
GORD
Ex:
Large tongue
crowding mid facial feactures
narrow palate
micrognathia
short/broad neck
CVS/resp EX + IX
Hypotonia
Key:
1. Difficult BMV
2. Bradycardia —> consider pre-induction atropine + early attach ECG + 6% sevo/dial back sooner
3. Difficult PIVC
4. Avoid a2 agonist maybe - bradycardia (2microg/kg) - but faster
5. If intubate - CMAC
Pyloric stenosis
1:350
80% male
hypochloraemic
alkalosis
dehydrate
never urgent –> resus
PERIOP:
- risk of asp due to GOO
- NGT
- RSI+cric if NG loss >2mL/kg/h
rectus sheath block if laparoscopic
remove NGT end of surg
Extubate awake
Risk of apnoea (worsened by alkalosis)
Resus and replace NG loss with NS 0.9%
Emergency drug doses
- Sux (IV/IM)
- Atropine
- Adrenaline (anaphylaxis/arrest)
- Adenosine
- Amiodarone
Shock
Cardioversion
sux IM 4mg/kg
sux IV 1.5-2mg/kg
atropine 20microg/kg
adrenaline
anaphylaxis 10microg/kg
arrest 10/kg
*reduce to 1microg/kg in LAST
adenosine
100–>200–>300microg/kg
amiodarone
5mg/kg
Shock
arrest 4J/kg
other 1–>2–> 4Jg
Pros and cons of T piece
Pros:
1. Low resistance
2. valveless
3. lightweight
4. expiratory limb > Vt - prevent emtrainment of room air during SV
5. assess Vt
6. PEEP/CPAP by occluding bag
7. potential of assisted/controlled ventilation
8. Lung compliance
9.
Cons:
1. Up to 20kg, inefficient beyond
2. Scavenging is limited
3. FGF min 3L for most
4. FGF dependent of RR - high RR = high FGF
CMT
prejx
muscle atrophy - spinal/limb —> kypho
Key
1. RLD
2. Neuropathic pain
3. Avoid sux
4. inc sens to NDMB
cvs/resp/drugs/triggers
Friedreich’s
AR
Skeletal muscle weakness
Key
1. Risk of RF
2. cardiac involvement
3. avoid sux - debility —> hyperK
4. inc sens to NMDB
Duchenne
Beckers
X-linked recessive
- lack of dystrophin (duchenne)
- partial lack (beckers)
Prox muscle wasting
CVS/RESP failure
Can be normal at birth, weakness before 8, WC by adolescence
Key:
1. DCM - negative inotropes…
2. RLD
3. risk of AIR (anaes induced rhabdo) - HALOGENATED
- absent
