Pediatric/Neonatal Flashcards
Fontanelles
Anterior Fontanelle - closes 12-18 months
Posterior Fontanelle - closes in 2 months
Pediatric/Neonatal BP
infant <44 weeks post-conceptual [Age (wks)] = MAP
infant >44 weeks post-conceptual [age (yrs) x2] + 90 = systolic / +70 = min. systolic
ETT Size
Weeks gestation = move decimal point
[(age+16)/4]
x4 for chest tube size
3 H’s for tachycardia (pediatric)
Hypoxia
Hypovolemia
Hypotension
Pediatric Pericarditis
Viral/Bacterial
Unable to lay supine
Pain radiates to base of neck
Global ST elevation - no reciprocal patterns
Down sloping P-R interval
STABLE (Pediatrics)
Sugar
Temperature
Airway
Blood Pressure
Lab Values
Emotional Support
NRP
> 100 HR
Resuscitate with PPV
Compressions
1m = 60%
5m = 80%
10m = 85%
If after 24 hours, it’s still <90%. Probably a congenital heart defect.
Pediatric Fluid Maintenance
Bolus
<44wks = 10ml/kg
>44wks=20ml/kg
4-2-1 rule
4ml per 1kg up to 10kg +
2ml per kg up to 10kg +
1ml per kg for every 1kg after.
Neonate Fluid/Dextrose Maintenance
60-80ml/kg/day of D10 if <28 weeks
100ml/kg/day of D10 if >28 weeks
GIR
6-8mg/kg/day <28 weeks
Fetal Circulation
Oxygenated blood from the placenta travels through the umbilical vein to the fetus.
A portion of this blood travels through the ductus venosus and enters the inferior vena cava, bypassing the liver.
Blood enters the right atrium of the heart.
Most of the blood bypasses the lungs by flowing through the foramen ovale into the left atrium or through the ductus arteriosus into the aorta.
Blood in the left atrium enters the left ventricle and is pumped into the aorta.
The aorta carries the oxygenated blood to the rest of the body.
Deoxygenated blood returns to the placenta through the umbilical arteries.
MR. SOPA
Mask Adjustment
Reposition Airway
Suction mouth and nose
Open the mouth
Pressure Increase
Alternative Airway
NRP
Initial Assessment
APGAR?
Initial steps:
Warmth
Position Airway
Clear secretions
Dry
Stimulate
Respiratory Distress or HR <100? PPV
HR <60? Compressions
Still <60? Epinephrine
Cyanotic vs Acyanotic Lesion
Will oxygenation harm this patient?
Cyanotic - YES - Prostaglandin
Acyanotic - NO
Truncus Arteriosis
Single artery that arises from ventricles
Associated large VSD. (ventricular septal defect)
Maintain PDA patency
Prostaglandin Treatment
Needs surgery.
**How to close PDA/VSD Indomethacin administration
Transposition of the Great Vessels
Survival rate >97%
Severe Hypoxia
Left ventricle connected to pulmonary artery.
Right ventricle connected to aorta.
Surgical Intervention:
Prostaglandin Treatment for PDA and VSD.
Tricuspid Atresia
Tricuspid valve fails to grow; instead, a plate of tissue forms in its place.
Underdevelopment of right ventricle.
ASD/VSD present.
Maintain PDA
Prostaglandin
Surgical Shunt Procedure
Tetralogy of Fallot
Large VSD
Upward displacement of aorta
Stenotic pulmonary valve/artery
RV Hypertrophy
Treatment:
Prostaglandin Therapy
Surgical Repair
Total Anomalous Pulmonary Venous Return
Pulmonary Veins do not connect and drain into left atrium like normal.
Instead, connection into right atrium via an anomalous connection.
Maintain PDA
Prostaglandin
Surgical Repair to connect back to left atrium
Coarctation of the Aorta
Narrowing of outflow side of aortic arch, usually distal of left subclavian bifurcation.
Diagnosis usually happens after newborn has gone home.
Closure of PDA leads to decompensation.
BP 15mmHg higher in upper extremities.
Upper and lower extremities will have a distinct different look. Lower will be cyanotic.
Hypoplastic Left Heart
Critically ill once the PDA begins to close - ductal dependent.
No increased oxygen.
Treatment:
Fi02: <0.21
Add other gases to decrease Fi02.
Prostaglandin
Norwood and Glen surgical procedures.
Hirschsprung
Unable to pass meconium in the first two days of life.
Abdominal Swelling and vomiting.
Nerve cells to not develop normally. Unable to relax and pass stool.
