Pediatric Respiratory A&P & PeriOperative Considerations - Quiz 2 Flashcards
What can you do to relieve an Older Kid’s or an Adolescent’s fear of Loss of Control?
Explain Induction Steps
What should be included in a Pediatric Pt’s Pre-Op Assessment in addition to Head to Toe?
Anesthesia History
Premature Birth - Lung Problems
Developmental Delays
Consent is provided by the parent and _____ is provided by the child
Consent is provided by the parent and Assent is provided by the child
What can be used to Pre-Medicate Pediatric patients?
TLC
Distractions
Versed
Fentanyl/Morphine
Ketamine
Clonidine
Precedex
What is the first monitoring equipment that should be placed on Pediatric Patients?
Pulse Ox –> EKG –> BP Cuff
What is the 1st stage of Anesthesia?
Awake
&
Eyes Midline
What is the 2nd stage of Anesthesia?
Hyper-Excitable
&
Eyes Divergent
What is the 3rd Stage of Anesthesia?
Asleep
&
Eyes Midline
What is the 4th Stage of Anesthesia?
Anesthetized CV Reflexes - Bradycardia & Hypotension
&
Eyes Midline
What makes IV Induction advantageous over Gas Induction?
Asleep w/o goin thru Stage 2 of Anesthesia
&
Low Laryngospasm Risk
What is the difference between a Pediatric Airway vs an Adult Airway?
Cricoid Cartilage - Narrowest Part & Cone-Shaped
Longer & Narrower Epiglottis w/ more Acute Angle
Shorter Neck
Larger Head, Occiput, Tongue, & Adenoids
What is the difference b/t a Pediatric Larynx vs an Adult Larynx?
Pediatrics Larynx is Smaller & More Anterior & Cephalad @ C3-C4
What makes a Mainstem Intubation more likely in Pediatrics?
Short Trachea & Bronchus
What are the N/V Prophylaxis that can be given to Pediatrics Intra-Op?
Decadron & Zofran for kids > 1 yo
&
Fluids 10-20 mL/kg Bolus, then 4-2-1 Maintenance
What is typically seen in Pediatrics during Post-Op in regards to Cardiovascular?
Tachycardia - Excitement, Fear, Pain
&
Hypotension in Older Kids/Teens
Why shouldn’t the child be stimulated until they’re fully awake in the PACU?
Stage 2 of Anesthesia - Excitement - Laryngospams
Extubate/Remove LMA Deep
Transport w/ Mask, Oral Airway, O2, & Sux
How do Fatigued children affect the Anesthetic Plan?
1/2 Dose of Opioids for Fatigued kids & kids w/ OSA
&
Narcan 0.5 mcg/kg
What med is given for PONV in Pediatrics?
Zofran 0.1 - 0.5 mg/kg
If a kid wakes up upset or crying, what can be the reason other than pain?
Hunger
When do teeth erupt & shedding begin?
Teeth @ 6 Months
Shedding & 6-8yrs
What is the shape of the Unformed Hyoepiglottic Ligament that can make it difficult to Compress w/ a Mac Blade?
Omega-Shaped
Infants are Nose Breathers til 3-5 months of age. At this time, where is the major source of Airflow Resistance?
Lower Airways
What happens if an Infant’s Nares are occluded?
Complete Airway Obstruction
What do kids < 6 months primarily rely on for breathing?
Diaphragmatic breathing w/ 20-40% from Ribcage & Intercostal Muscles
How does a child’s mechanism of breathing change at 9 months & 12 months?
9 Months: 50% from Ribcage
12 Months: Stable Chest Wall & Resists Inward Lung Recoill
Why is the FRC of an Infant not as functional as an Adult’s FRC?
Infants consume 2-3x more Oxygen
How is the ETT Size for a kid determined?
Uncuffed: [Age + 16] / 4
Cuffed: 1/2 size smaller
For a child, at what pressure should you hear an air leak?
15-25 cm H2O
What is the Main cause of Post-Op Croup?
ETT too big
Contraction of which Adductor Muscles results in Laryngospasms?
Lateral Cricoarytenoids
Thyroarytenoids
Cricoarytenoids
What are the causes of Laryngospasms?
Volatile Agents
Excessive Secretions
URI
Airway Manipulation
Visceral Nerve Stimulation in the Pelvis, Abdomen, & Thorax
How are Laryngospasms treated?
Remove Irritating Stimulus & Debris
Deepen Anesthesia
100% O2
Positive Pressure - 40 cm H2O
Airway Maneuvers
Sux - 0.4 mg/kg IV or 4 mg/kg IM
Atropine 20 mcg/kg
What complication of Intubation is greatest in children 1-4 yo?
Laryngeal Edema d/t trauma or ETT too tight
How can Laryngeal Edema be treated?
Humidified Gas
Racemic Epi
Re-Intubation
Trach
What is the condition that occurs in kids 3-6 yo that is caused by Haemophilus Influenza B
Epiglottitis - affects epiglottis and up
What are symptoms of Epiglottitis?
Fast Progressing
Dysphagia
Dysphonia
Drooling
Stridor
High Fever
What is the Treatment for Epiglottitis?
O2
Urgent Intubation - under GA & in the OR w/ ENT
ABX
Antipyretics
Fluids
What size should the ETT be for intubating a kid w/ Epiglottitis?
1.5 x smaller than normal
Which condition is caused by Parainfluenzae 1 & 2, Influenza A, & RSV in kids < 2 and accounts for 90% of Upper Airway Obstruction in children?
Laryngotracheobronchitis - Subepiglottic infection w/ swelling w/in Cricoid Ring
What are symptoms of Laryngotracheobronchitis?
Gradual Progression - 24-72 hours
URI progressing to Hoarse Cry/Barking Cough
Low Grade Fever
How is Laryngotracheobronchitis treated?
O2 w/ Cool Mist
Racemic Epi
Corticosteroids
Antipyretics
Intubation is RARE
What are symptoms of Foreign Body Aspiration?
Cough
Wheeze
↓Air Entry
URI
Pneumonia
What is the preferred method of Induction for a pt w/ an Airway Obstruction?
Gas Induction w/ Spont. Ventilation
Avoid NMBs & Positive Pressure Ventilation
What are complications of Foreign Body Aspiration?
Airway Obstruction
Fragmentation of Object
Arterial Hypoxemia
Hypercarbia
Subglottic Edema
