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Pediatric Physiology - B. Stevens/Bernstein 2017 > Pediatric Emergencies - Quiz 2, Part 2 > Flashcards

Pediatric Emergencies - Quiz 2, Part 2 Flashcards

1
Q

4 things that matter with a foreign body aspiration

A
  1. the surgeon
  2. your experience
  3. the object - what is it?
  4. location of the object
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2
Q

Where would you anticipate finding a foreign body if the pt is drooling w no airway distress?

A

Esophagus

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3
Q

Where would you anticipate finding a foreign body if the pt is drooling and coughing?

A

Upper airway/pharynx

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4
Q

Where would you anticipate finding a foreign body if the pt is in resp distress?

A

Airway

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5
Q

2 drugs that you should give to a child with a foreign body as soon as you have an IV

A
  1. Atropine

2. Steroids

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6
Q

What type of induction should a FB child have?

A

inhaled induction with spontaneous ventilation

Gently take over ventilation and give 100% O2

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7
Q

Things to consider/do with an esophageal foreign body

A
  1. It could have moved
  2. consider it a full stomach
  3. get an IV
  4. give an anticholinergic
  5. RSI
  6. have McGill forceps handy
  7. Intubate
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8
Q

Every fracture is a ____________

Why?

A

Full stomach

  1. anxiety = gastroparesis
  2. pain = gastroparesis
  3. narcotics for pain = gastroparesis
  4. swallowed spit accumulates (30 m/L/kg/day)
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9
Q

True or false. If a child is having a closed reduction, you can expect less pain post op than pre op

A

Ture

Esp if it is at night, cut the narcs during the surgery so they will breathe and wake up at the end. Exhaustion in kids does count toward MAC

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10
Q

What should you try to never do in a child with a ruptured globe?

A

Rile them up (you may have to premedicate them)

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11
Q

Theoretical risk of using SCh in a ruptured globe case

A

Succs increases intraocular pressure (with fasciculations)

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12
Q

2 differences to consider when debating whether to use SCh or NDNMB for RSI

A
  1. Side Effects
  2. How quickly relaxation goes away

Speed of onset isn’t an issue

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13
Q

2 types of sedation that may be appropriate for a ruptured globe

A

Oral
IM
may be less agitating than starting an IV

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14
Q

Why would a deep extubation be appropriate after repair of a ruptured globe?

A

it avoids coughing and increased IOP

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15
Q

Things to know about bleeding post T&A

A
  1. Extent of blood loss
  2. Rate of blood loss
  3. Are they still bleeding?
  4. Vital signs
  5. Tachycardia, HoTN - give fluid
  6. Why was it done in the first place? (infection vs sleep apnea)
  7. Get labs (Hgb and T&C)
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16
Q

How suction should be used in a post T&A pt

A

Use it a lot if they are bleeding

Don’t use it at all if they are not actively bleeding

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17
Q

What concern would be associated if a child presents in the middle of the night for bleeding post T&A if the T&A was done for sleep apnea?

A

They probably have an altered resp drive and you are in the ZZZzzzz part of the circadian rhythm

18
Q

True or false. The more a VP shunt gets revised, the more often it will need subsequent revision

19
Q

True or False. VP shunt revisions are not emergencies

A

False.

They are emergencies no matter how they present even if they are awake w just a headache

20
Q

ICP mgmt for a pt w hydrocephalus

  1. Acute medical
  2. Less acute
  3. Surgical
A
  1. Hyperosmolar therapy
    • Mannitol
    • 3% NaCl
      - tracheal intub and hyperventilation
  2. Diamox
  3. Tap fontanel
    - Shunt - fix or place
21
Q

In what situation would a VP shunt revision require hyperventilation?

A

If you need to decrease ICP

22
Q

In what situation would a VP shunt revision require hypoventilation?

A

To facilitate accessing the ventricle

23
Q

2 things to discuss w surgeon prior to VP shunt revision

A
  1. expected initial ventilation mgmt

2. what is the problem? proximal vs distal obstruction

24
Q

True or False. Deep extubation is recommended for VP shunt repairs.

A

False. The pt should be wide awake at extubation

25
Why should you limit narcs on VP shunt repairs?
1. their headache will be gone after surgery | 2. they need to be alert so that mental status can be monitored
26
True or False. Pediatric trauma will require mostly the same management principles as adult trauma.
True although post-op analgesic strategies may be different
27
neonatal emergencies that require immediate intervention
1. Bowel obstructions 2. midline and wall defects 3. airway issues 4. esophageal atresia 5. CDH 6 Tetratomas
28
Things to anticipate when dealing with a NEC (necrotizing enterocolitis) pt
1. pulm aspiration 2. hypovolemmia 3. sepsis 4. coagulopathy/thrombocytopenia 5. pulm compliance issues
29
How to prevent pulm aspiration in a NEC pt
1. decompress with OG tube prior to intubation 2. RSI or awake intub 3. If they're already intubated and already aspirated, expect significant difficulty ventilating and high FiO2 requirements
30
causes of high 3rd space losses in NEC pts
1. High evaporative loss | 2. Extensive bowel manipulation
31
Why might a NEC pt have difficulty breathing?
diaphragm is impeded by increased and pressure
32
5 Notable aspects of NEC anesthesia technique
1. Narcotic-based anesthetic +/- gas 2. always check EtCO2 against venous or arterial ABG 3. RR >50 commonly needed 4. Tx acidosis aggressively w ventilation and bicarb 5. Beware of reversion to fetal circulation
33
What is EA/TEF?
Esophageal Atresia/TracheoEsophageal Fistula
34
EA/TEF s/s and diagnosis (5)
1. Polyhydramnios 2. Resp distress w feeding 3. Drooling 4. Inability to pass OG tube 5. CXR
35
TEF and VACTERL association. What is VACTERL?
``` V - Vertebral or Vascular A - Anal atresia C - Cardiac T - TEF E - EA R - Renal anomaly L - Limb anomaly ```
36
Most common cardiac anomaly associated with TEF
VSD
37
What temp should the OR be for repair of EA/TEF?
26-28*C also have lamps, blankets, circuit, and plastic warm
38
Where should the tip of the ETT be when managing anesthesia for TEF repair?
Distal to the fistula
39
In TEF anesthetic mgmt, positive pressure ventilation should be avoided until...
the fistula is ligated ...and even then avoid high PIP and PEEP
40
Differences in circulation for a baby who is unborn, being born (transitional), and an adult
Unborn baby: - Pulm bed = high resistance - R side of heart is decompressed: atrium and ductus Transitional: - SVR rises when umbilical cord clamped - PVR falls when baby begins breathing and pO2 increases - L --> R flow at atrium and ductus (persistent fetal circulation is possible) Adult - R & L sides in series, no shunts

Pediatric Physiology - B. Stevens/Bernstein 2017 (7 decks)

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