Pedi Board Facts Flashcards
Placenta not allow insult and glucagon pass through?
- no, placenta is impervious to insulin and glucagon
Contraindications of cricoid pressure?
- 2 layers of cervical level: trachea, esophagus and cervical spine
- no cricoid if:
+ trachea: tracheal ring fracture, sharp foreign body in trachea
+ esophagus: zenker diverticulum, sharp foreign body
+ spine: sharp foreign body (knife?), unstable c spine
If child has swallow coin, how do you know if coin is in esophagus or trachea?
- if in esophagus XRAY will appear flat
- if in trachea, X-RAY will appear rotated 90 degrees will not be flat
Cerebral perfusion and CO2, O2
- In neonatal, goal PO2 70-90 mmHg
- PO2 > 100 mmHg harmful to lungs and cerebral perfusion (hyperoxia- cerebral vasoconstriction)
- PCO2 low -> cerebral vasoconstriction
- PO2 low -> cerebral vasodilation
Pt is allergic to penicillin what is alternative?
- clindamycin 20mg/kg
Pulses paradoxus
- pulses paradoxus seen as late finding in cardiac tamponade ( hypotension, jugular vein distention, pulsus paradoxus)
- pulsus paradoxus = drop in systolic BP > 12 mmHg during inspiration caused by reduced LV stroke volume due to increased filling pressure of right heart during inspiration
- not sensitive nor specific
- beck’s triad for cardiac tamponade - Low pressure in the arteries (hypotension)
Bulging (distended) neck veins.
Muffled heart sounds. - dyspnea is the earliest and most sensitive symptom of cardiac tamponade
Separation anxiety when?
- 6-12 months old -> give versed starting at this age group
How much fluid to give to prevent PONV?
- crystalloid 30ml/kg is sufficient to prevent PONV
Going to higher altitude, percent concentration of volatile anesthetics going up or down?
- higher altitude, percent concentration of isoflurane delivery goes up compared to sea level
+ partial pressure DOES NOT change w altitude
+ output of vaporizer is the partial pressure not the percent concentration ( which is labeled on dial)
MEPs motor evokes potentials
- MEPs can be measured by direct transcranial stimulation of motor cortex or by spinal cord stimulation
- MEPs: neurogenic or epidural MEPs
- with spinal cord stimulation, neurogenic MEPs measured the conduction vua dorsal columns in a retrograde fashion —- MEPs is actually sensory in nature
- with epidural MEPs the recording electrodes in lower lumbar epidural space- they monitor conduction via corticospinal tract - not monitor motor conduction
- the CMAPs compound muscle action potentials generated after transcranial stimulation then transmitted via motor tract conduction in anterior horn of spinal cord
Mechanical dead space?
Mechanical dead space exists only where fresh and exhaled gases are mixed ie distant to the Y piece
MAC of isoflurane peak at what age?
- MAC of isoflurane peaks at 1-6 months of age
MAC of sevoflurance peaks at what age?
- MAC of sevoflurance peaks at full term new borns
Steroids prolong or shorten NMB?
- steroids prolongs muscle weakness from NMB
QT prolong syndrome - drugs that can trigger prolongation, Torsades se point
- succinylcholine (due to autonomic effect and Potassium release)
- ketamine
- atropine
- glycopyrrolate
- droperidol
- zofran
Iodine skin prep leads to thyroid suppression
Yes
Decadron bad side effects?
- avascular necrosis of femoral head with corticosteroid use in ALL acute lymphoblastic leukemia
- higher dose of decadron 0.5 mg/kg use has been associated with increased postoperative bleeding in tonsillectomy
MAC of volatile agents in neonates?
- listed in order of most potent to least potent
+ isoflurane (1.6) > sevoflurance (3.3) > desflurance (9) > N2O (104)
Closing capacity of infants, children compared to adolescents?
- infants, children have HIGHER closing capacity compared to adolescents -> atelectesis, airway collapses during normal respiration
- closing volume is lung volume at which terminal airways begins to collapse
Ventilation and perfusion of lung in infants/children vs adults?
- different in children vs adult in ventilation V and perfusion P
- in adults, due to gravity, V and P are preferred to DEPENDENT lung regions
- in infants & small children, V is greater in NON DEPENDENT, P is evenly distributed throughout lung
Inspiratory stridor?
- inspiratory stridor = supraglottis or glottis obstruction
- biphasic stridor = glottis obstruction
- expiratory stridor = distal trachea or mainstem bronchi obstruction
When sympathetic nervous starting to mature?
- ~ 6 months old
Craniopharyngioma need stress dose steroid?
- yes
- craniopharyngioma -> ACTH deficiency -> stress dose corticosteroid perioperatively
- also see hypothyroidism due to mass effect
- surgery by transcranial approach
Beck with wiedenmann
- hypoglycemia hyperinsulinemia
- omphalocele
Hyponatremia in subarachnoid hemorrhage kid?
- cerebral salt wasting
- can also occur in brain tumors
Conn dz?
- conn dz = primary hyperaldosteronism
- hyper Na, hypoK, metabolic alkalosis
-
Which factor deficiency the treatment is FFP?
- factor V deficiency
- factor XI deficiency
Female Duchene muscular dystrophy prompt to what?
- female carriers of duchene muscular dystrophy may have
+ underlying cardiomyopathy that can result in cardiac failure intraoperative
+ rhadomyolysis, hyerK arrest w volatile anesthetics or succinylcholine
Pt w myotonic congenita has sustained muscle contractions intraoperative, treatment?
- sodium channel blocker procainamide
Mitochondrial myopathies pt what fluid should be used?
- mitochondrial myopathies cause inefficient oxygen use and ATP generation so use d5% NS for fluid
- avoid LR due to lactate of LR
- want d5% to supply energy
- avoid prolonged propofol infusion
Which syndromes is the airway management worse with age?
Which syndrome is airway get better with age?
- worse with age: Treacher Collin, CHARGE syndromes
- better with age: Pierre Robin sequence
When Physiologic anemia in full term neonate vs preterm neonates?
- full term neonates 9-12 weeks 10-11 g/dL
- preterm neonates 5-8 weeks 7-8 g/dL
When babies double weight? Triple weight?
- most babies double weight by 4 months, triple weight by 1 year
Best induction agent for Tetralogy of Fallot?
- ketamine as it maintains SVR
Charcot Marie tooth dz which drugs to avoid?
- Charcot Marie tooth dz is neuropathy dz effecting motor and sensory neurons
- avoid N2O, Serotonin reuptake inhibitors like Prozac, Zoloft, Paxil, Luvox - these drugs are neurotoxic to Charcot Marie tooth pts
-
Pt for repair of complex thumb/ index finger syndactyly. What’s preop testing needs to be done?
- Apert or Potter syndromes- syndactyly
- need to rule out QT prolong syndrome -> EKG needed
Which syndromes becomes more and more difficult to intubate as one gets older?
- treacher Collins
- goldenhar
Anatomy of CNS in a newborn?
L3 S3
- L3 conus medullaris
- S3 dural sac
