pediatric Flashcards

1
Q

main take away from peds population

A

if something bad is going to happen – it happens much quicker in children so need to respond at a good time

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2
Q

main thing with GA

A

complete or partial loss of reflexes

like have to brethe for them - inability to maintain a patent airway or respond to verbal or physical stimulus

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3
Q

minimal sedation

A

respond everything basically the same

respond NORMALLY

type given before GA

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4
Q

moderate sedation

A

response purposefully to verbal commands and maintain airway

cardio and resp adequate and maintained

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5
Q

when can peds patient take the oral med for minimal

A

once arrive at the office

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6
Q

deep sedation

A

aroused with repeated verbal or painful stimulus

partial or complete loss of protective airway
- assistance to airway may be necessary

cardio function maintained !

response = purposeful to pain 
airway = +/- interventon 
ventilation= +/- inadequate 
cardio = +/- maintained
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7
Q

narrowest part in peds airway

A

cricoid ring - narrowest

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8
Q

child talking what age

A

under age of 12

- when referring to anatomics

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9
Q

large ___ in kids ?

tracheal lenght?

A

large tongue and epiglottis
enlarged adenoids and tonsils
- reach max at 6-8

short neck

anterior placed airway and is funnel shaped

narrow nasal pasasges

trachea is 4-5.5 cm
- every mm of trauma = 60% decrease in size

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10
Q

cranial vault to airway in child

A

rapid cause upper airway oobstruction

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11
Q

breathing differnces

A

children - see more abdominal movement

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12
Q

FRC in children

A

5:1

reserve is small
so get hypoxemia faster - respiratory arrest faster then bradycardia then death

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13
Q

physiological differences in children

A

higher metabolic rates
- need more oxygen

greater frequency of breathing

FRC = 5:1

smaller reserve

more suceptible to hypoxemia

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14
Q

intermittent asthmatic patient?
mild persistent
moderate persistent
severe persistent

A

symptoms no more than 2 / days a week

mild = greater than 2 days

moderate = daily

severe = throughout the day have symptoms

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15
Q
range of age 
neonates
infants
children
adolescents
A

0-30 days
1-12 months
1-12 years
13-18 years

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16
Q

Cardiac output it ___ dependent

A

rate dependent and by vagal parasympathetic tone predominates

cardiac output is 300-400 ml/kg min @ birth

200-300 ml /kg/ min - infants and children

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17
Q

blood volume in newborn
6 weeks to 2 years
2 years - puberty

A

85-90 ml/kg

85 ml/kg

80 ml/kg

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18
Q

smaller blood volume in

A

children
- rate dependent
so vasovagal attack is cardio

HR is higher

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19
Q

blood volume of adult

A

5 liters

20
Q

HR in peds

A

naturally higher

new born is 120 average

10 years is 90

21
Q

so what would bradycardia be in a younger child

A

age dependent

less than 16 average can be 75 - 80

22
Q

how to decide technique to help with anxiey with child

A

age
level
urgency of tx
type of procedure

23
Q

typical under sedation with pedo

A

oral prophylaxis
dental restortions
dental extractions
dento alveolar sugical procedures . pathology, trauma, impaacted teeth removal

make sure airway is patent

24
Q

GA use?

A

when more severe

25
Q

pre operative assessment

A

age, body weight

last meal or drink?
- can vomit easily

medical history – important to ask

  • CHD?
  • asthma?
  • bleeding disorders?

recent ilnness like URI?

allergies?

previous exerience with anesthesia?

family history?
- like malignant hyperthermia

26
Q

recent URTI?

A

airway narrow
more likel to have upper airway obstruction faster

can be contraindication

27
Q

monitor if going to sedate?

A

HR, pulse oximiter SPO2, BP, Resp rate

examination of head and neck
- airway, size of tongue, tonsils, patency of nares, range of motion of neck, mouth opening

chest exam and auscultation
- shape, breath sounds, heart sounds, murmers

28
Q

last meal - solids, and liquids
6-36 monhts
over 3 years?

A

6-36 months greater than 6 hrs for solids, 2 hrs for liquids

over 3 years 6-8 hours for solids, 2 hrs for clear liquids

29
Q

T/F aspiration is an independent risk factor

A

True

30
Q

measure a nasal laryngoscope

A

nose to angle of the mandible

31
Q

airway in terms of stiff and collapsable

A

nasal segment - cartilage and palate

pharyngeal segment – soft portion - is collapsable

tracheal segment

can get pharyngeal collapse during sedation

posture of patient is important
- giving positive pressure - able to open up the collapsed portion

32
Q

monitoring equipment

A

pre-cordial stethescope

pulsoximeter

BP monitor
capnograph
ECG

33
Q

Local anesthesia

A

weight based

wait till anesthetic takes effect

34
Q

max LA for child

A

7.0 mg/kg for articaine

35
Q

anxiolytics / sedatives used in children

A

benzo = midazolam (most likely to use) , valium
antihistamines - hydrocyzine (vistarill)

sedative / hypnotics
- chloral hydrate

narcotics
- fentanyl, meperidine

36
Q

N20 use

A

inhalation
- good one to use with children

dissociates quickly

37
Q

enteric

A

goes through GI

ora, rectal, intranasal

38
Q

parenteral

A

IM and IV

39
Q

dose of midazolam in child

A

.25 -.5 mg/kg PO or .2 to .3 mg/kg IV

better amnesia than valium**

can be reversed with flumazenil

water soluble – makes it not as painful on injection

40
Q

opioid use in pediatric sedation

A

pediatric mortality and morbidity incresed when opiates + other sedatives used

41
Q

snoring indicates

A

hypopharngeal obstruction

42
Q

stridor means

A

laryngospasm

43
Q

what is a sign of hypoxeia

A

bradycardia

44
Q

what is a sign of hypoxeia

A

bradycardia

45
Q

biggest emergency when sedating patietn

A

emesis, and aspiration