Pediatric/Neonatal

Question 1

Fontanelles

Answer 1

Anterior Fontanelle - closes 12-18 months
Posterior Fontanelle - closes in 2 months

Question 2

Pediatric/Neonatal BP

Answer 2

infant <44 weeks post-conceptual [Age (wks)] = MAP
infant >44 weeks post-conceptual [age (yrs) x2] + 90 = systolic / +70 = min. systolic

Question 3

ETT Size

Answer 3

Weeks gestation = move decimal point

[(age+16)/4]
x4 for chest tube size

Question 4

3 H’s for tachycardia (pediatric)

Answer 4

Hypoxia
Hypovolemia
Hypotension

Question 5

Pediatric Pericarditis

Answer 5

Viral/Bacterial

Unable to lay supine
Pain radiates to base of neck
Global ST elevation - no reciprocal patterns
Down sloping P-R interval

Question 6

STABLE (Pediatrics)

Answer 6

Sugar
Temperature
Airway
Blood Pressure
Lab Values
Emotional Support

Question 7

NRP

Answer 7

> 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.

Question 8

Pediatric Fluid Maintenance

Answer 8

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.

Question 9

Neonate Fluid/Dextrose Maintenance

Answer 9

60-80ml/kg/day of D10 if <28 weeks
100ml/kg/day of D10 if >28 weeks

GIR
6-8mg/kg/day <28 weeks

Question 10

Fetal Circulation

Answer 10

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.

Question 11

MR. SOPA

Answer 11

Mask Adjustment
Reposition Airway

Suction mouth and nose
Open the mouth
Pressure Increase
Alternative Airway

Question 12

NRP

Answer 12

Initial Assessment

APGAR?

Initial steps:

Warmth
Position Airway
Clear secretions
Dry
Stimulate

Respiratory Distress or HR <100? PPV

HR <60? Compressions

Still <60? Epinephrine

Question 13

Cyanotic vs Acyanotic Lesion

Answer 13

Will oxygenation harm this patient?

Cyanotic - YES - Prostaglandin
Acyanotic - NO

Question 14

Truncus Arteriosis

Answer 14

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

Question 15

Transposition of the Great Vessels

Answer 15

Survival rate >97%

Severe Hypoxia

Left ventricle connected to pulmonary artery.

Right ventricle connected to aorta.

Surgical Intervention:

Prostaglandin Treatment for PDA and VSD.

Question 16

Tricuspid Atresia

Answer 16

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

Question 17

Tetralogy of Fallot

Answer 17

Large VSD

Upward displacement of aorta
Stenotic pulmonary valve/artery

RV Hypertrophy

Treatment:

Prostaglandin Therapy
Surgical Repair

Question 18

Total Anomalous Pulmonary Venous Return

Answer 18

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

Question 19

Coarctation of the Aorta

Answer 19

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.

Question 20

Hypoplastic Left Heart

Answer 20

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.

Question 21

Hirschsprung

Answer 21

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.