Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Principles III > Pediatric Emergencies > Flashcards

Pediatric Emergencies Flashcards

1
Q

What is postintubation croup and when does it occur?

A

aka subglottic edema, usually becomes symptomatic within the first hour after extubation with maximum edema usually occurring at 4 hours after extubation and resolving by 24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are some signs and symptoms of postintubation crup?

A

“barking,” stridor, retractions, hypoxemia, mental status changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are some causes of postintubation croup?

A

traumatic or repeated intubations, tight fitting endotracheal tubes (air leak >25 cm H2O), high pressure/low volume cuff, prolonged intubations, surgery of the head and neck, coughing “bucking” on the tube, changing the patients position after intubation, and history of croup

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the treatment for laryngospasm?

A
  • remove precipitating factor
  • positive pressure with 100% FiO2
  • jaw thrust
  • deepen the anesthetic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the dose of propofol for laryngospasm?

A

1-2 mg/kg IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the dose of lidocaine for laryngospasm?

A

1-1.5 mg/kg IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the dose of IV Succ for laryngospasm?

A

0.5-1 mg/kg IV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the dose of IM succ for laryngospasm?

A

4 mg/kg IM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the treatment for postintubation croup?

A
  • humidified oxygen by mask adding racemic epinephrine (0.25-0.5 mL of a 2.25% solution in 3 mL of NS) administered by nebulization mask
  • consider dexamethasone (0.5 mg/kg IV)
  • consider prolonged observation and overnight admission
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is acute epiglottitis?

A

inflammation of supraglottic structures that can occur at any age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are common pathogens for acute epiglottitis?

A

haemophilus influenza type B (also herpes simplex, meningococcal, streptococcus, staphylococcus, mechanical injury, and illicit drug inhalation of heated objects)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the presentation of a patient with acute epiglottitis?

A
  • sore throat, fever, muffled voice, dysphagia
  • rapidly increasing stridor
  • rapid onset over 24 hours
  • sitting, learning forward, drooling “tri-pooling”
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the radiological “thumb sign”?

A

indicate of severe inflammation of the epiglottis with potential for irrevocable loss of the airway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Are laboratory tests helpful in diagnosing acute epiglottitis?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the anesthetic management of acute epiglottitis?

A
  • direct inspection should only be performed in the operating room by the surgeon and under anesthesia with the intention to intubate
  • if airway is judged to be at risk, intervention should not be delayed by attempts to attain cultures or radiographs
  • strict monitored conditions int he operating room while maintaining spontaneous ventilations
  • have team capable of performing immediate tracheotomy if needed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What induction should you do for acute epiglottitis?

A
  • inhalation induction (prevent child from crying which will complete airway obstruction) or IV induction sitting with spontaneous respirations
  • muscle relaxant avoided
  • fiberoptic nasal intubation or rigid bronchoscopy using ETT with substantially reduced diameter
17
Q

What should you do once you are able to intubate a patient with acute epiglottitis?

A

secure airway, transfer to ICU, sedated and restrained to avoid extubation
direct observation to determine proper time to extubate (fever resolved, and other signs of infection decreased, cuff leak test with deflated cuff, airway examination by direct or flexible fiberoptic laryngoscopy to confirm inflammation of the epiglottis has resolved)

18
Q

What is the anesthesia technique for a distal larynx or trachea obstruction?

A
  • inhalation induction
  • maintain spontaneous respiration (avoid assisted ventilation if possible)
  • turn bed
  • rigid bronchoscope
  • full stomach - RSI - be prepared for full airway occlusion
  • induce with all team members in the room (esp ENT)
  • post-removal - may need intubate the trachea to provide ventilation during emergence
  • edema may occur for the next 24 hours
19
Q

What are potential complications of airway obstruction?

A
  • aspiration and loss of airway with a full stomach
  • prolonged inhalation induction because of abnormalities associated with airway obstruction
  • possibility of forcing the FB distally
  • intense reaction to the FB
  • residual edema
  • complete airway obstruction requiring cardiopulmonary resuscitation and ECMO
20
Q

How do you prepare the anesthesia gas machine for a MH patient?

A
  • remove or tape off the anesthetic vaporizers
  • remove or tape off succ
  • change CO2 absorbent
  • flow 10 L/min O2 through circuit and ventilator (each AGM varies in the recommended time of 20-60 minutes)
  • unused breathing bag should be attached to the Y-piece and inflate periodically
  • use a new breathing circuit
21
Q

What drugs can decrease the incidence of emergence delirium?

A

pretreatment of propofol, fentanyl, ketamine, clonidine, and dexmedetomidine

22
Q

What is emergence delirium?

A

characterized by disorientation, non-purposeful movements, failure to establish eye contact, inconsolable

23
Q

How long does emergence delirium usually last?

A

10-20 minutes

24
Q

What is the dose of epinephrine for hypotension and cardiac arrest?

A

hypotension: 1 mcg/kg IV

cardiac arrest: 10 mcg/kg IV

25
Q

What is the dose of atropine?

A

10-20 mcg/kg IV

26
Q

What is the dose of bicarbonate?

A

1-2 mEq/kg IV

27
Q

What is the dose of calcium chloride?

A

10-20 mg/kg IV

28
Q

What is the dose of calcium gluconate?

A

30-60 mg/kg IV

29
Q

What is the dose of adenosine?

A

100 mcg/kg rapid IV bolus (max 6 mg); second dose 200 mcg/kg (max 12 mg)

30
Q

What is the dose of lidocaine?

A

1 mg/kg IV

31
Q

What is the dose of amiodarone?

A

5 mg /kg IV

32
Q

What is the dose of procainamide?

A

5-15 mg/kg IV loading dose over 30-60 minutes, 20-80 mcg/kg/min gtt

33
Q

What is the dose of magnesium?

A

25-50 mg/kg IV

Principles III (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions