Pediatric Respiratory A&P & PeriOperative Considerations - Quiz 2

Question 1

What can you do to relieve an Older Kid’s or an Adolescent’s fear of Loss of Control?

Answer 1

Explain Induction Steps

Question 2

What should be included in a Pediatric Pt’s Pre-Op Assessment in addition to Head to Toe?

Answer 2

Anesthesia History

Premature Birth - Lung Problems

Developmental Delays

Question 3

Consent is provided by the parent and _____ is provided by the child

Answer 3

Consent is provided by the parent and Assent is provided by the child

Question 4

What can be used to Pre-Medicate Pediatric patients?

Answer 4

TLC

Distractions

Versed

Fentanyl/Morphine

Ketamine

Clonidine

Precedex

Question 5

What is the first monitoring equipment that should be placed on Pediatric Patients?

Answer 5

Pulse Ox –> EKG –> BP Cuff

Question 6

What is the 1st stage of Anesthesia?

Answer 6

Awake

&

Eyes Midline

Question 7

What is the 2nd stage of Anesthesia?

Answer 7

Hyper-Excitable

&

Eyes Divergent

Question 8

What is the 3rd Stage of Anesthesia?

Answer 8

Asleep

&

Eyes Midline

Question 9

What is the 4th Stage of Anesthesia?

Answer 9

Anesthetized CV Reflexes - Bradycardia & Hypotension

&

Eyes Midline

Question 10

What makes IV Induction advantageous over Gas Induction?

Answer 10

Asleep w/o goin thru Stage 2 of Anesthesia

&

Low Laryngospasm Risk

Question 11

What is the difference between a Pediatric Airway vs an Adult Airway?

Answer 11

Cricoid Cartilage - Narrowest Part & Cone-Shaped

Longer & Narrower Epiglottis w/ more Acute Angle

Shorter Neck

Larger Head, Occiput, Tongue, & Adenoids

Question 12

What is the difference b/t a Pediatric Larynx vs an Adult Larynx?

Answer 12

Pediatrics Larynx is Smaller & More Anterior & Cephalad @ C3-C4

Question 13

What makes a Mainstem Intubation more likely in Pediatrics?

Answer 13

Short Trachea & Bronchus

Question 14

What are the N/V Prophylaxis that can be given to Pediatrics Intra-Op?

Answer 14

Decadron & Zofran for kids > 1 yo

&

Fluids 10-20 mL/kg Bolus, then 4-2-1 Maintenance

Question 15

What is typically seen in Pediatrics during Post-Op in regards to Cardiovascular?

Answer 15

Tachycardia - Excitement, Fear, Pain

&

Hypotension in Older Kids/Teens

Question 16

Why shouldn’t the child be stimulated until they’re fully awake in the PACU?

Answer 16

Stage 2 of Anesthesia - Excitement - Laryngospams

Extubate/Remove LMA Deep

Transport w/ Mask, Oral Airway, O₂, & Sux

Question 17

How do Fatigued children affect the Anesthetic Plan?

Answer 17

1/2 Dose of Opioids for Fatigued kids & kids w/ OSA

&

Narcan 0.5 mcg/kg

Question 18

What med is given for PONV in Pediatrics?

Answer 18

Zofran 0.1 - 0.5 mg/kg

Question 19

If a kid wakes up upset or crying, what can be the reason other than pain?

Answer 19

Hunger

Question 20

When do teeth erupt & shedding begin?

Answer 20

Teeth @ 6 Months

Shedding & 6-8yrs

Question 21

What is the shape of the Unformed Hyoepiglottic Ligament that can make it difficult to Compress w/ a Mac Blade?

Answer 21

Omega-Shaped

Question 22

Infants are Nose Breathers til 3-5 months of age. At this time, where is the major source of Airflow Resistance?

Answer 22

Lower Airways

Question 23

What happens if an Infant’s Nares are occluded?

Answer 23

Complete Airway Obstruction

Question 24

What do kids < 6 months primarily rely on for breathing?

Answer 24

Diaphragmatic breathing w/ 20-40% from Ribcage & Intercostal Muscles

Question 25

How does a child's mechanism of breathing change at 9 months & 12 months?

Answer 25

**9 Months**: 50% from Ribcage **12 Months**: Stable Chest Wall & Resists Inward Lung Recoill

Question 26

Why is the FRC of an Infant not as functional as an Adult's FRC?

Answer 26

Infants consume 2-3x more Oxygen

Question 27

How is the ETT Size for a kid determined?

Answer 27

**Uncuffed**: [Age + 16] / 4 **Cuffed:** 1/2 size smaller

Question 28

For a child, at what pressure should you hear an air leak?

Answer 28

15-25 cm H₂O

Question 29

What is the Main cause of Post-Op Croup?

Answer 29

ETT too big

Question 30

Contraction of which Adductor Muscles results in Laryngospasms?

Answer 30

Lateral Cricoarytenoids Thyroarytenoids Cricoarytenoids

Question 31

What are the causes of Laryngospasms?

Answer 31

Volatile Agents Excessive Secretions URI Airway Manipulation Visceral Nerve Stimulation in the Pelvis, Abdomen, & Thorax

Question 32

How are Laryngospasms treated?

Answer 32

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

Question 33

What complication of Intubation is greatest in children 1-4 yo?

Answer 33

Laryngeal Edema d/t trauma or ETT too tight

Question 34

How can Laryngeal Edema be treated?

Answer 34

Humidified Gas Racemic Epi Re-Intubation Trach

Question 35

What is the condition that occurs in kids 3-6 yo that is caused by Haemophilus Influenza B

Answer 35

Epiglottitis - affects epiglottis and up

Question 36

What are symptoms of Epiglottitis?

Answer 36

Fast Progressing Dysphagia Dysphonia Drooling Stridor High Fever

Question 37

What is the Treatment for Epiglottitis?

Answer 37

O2 Urgent Intubation - _under GA & in the OR w/ ENT_ ABX Antipyretics Fluids

Question 38

What size should the ETT be for intubating a kid w/ Epiglottitis?

Answer 38

1.5 x smaller than normal

Question 39

Which condition is caused by Parainfluenzae 1 & 2, Influenza A, & RSV in kids \< 2 and accounts for 90% of Upper Airway Obstruction in children?

Answer 39

Laryngotracheobronchitis - Subepiglottic infection w/ swelling w/in Cricoid Ring

Question 40

What are symptoms of Laryngotracheobronchitis?

Answer 40

Gradual Progression - 24-72 hours URI progressing to Hoarse Cry/Barking Cough Low Grade Fever

Question 41

How is Laryngotracheobronchitis treated?

Answer 41

O₂ w/ Cool Mist Racemic Epi Corticosteroids Antipyretics Intubation is _RARE_

Question 42

What are symptoms of Foreign Body Aspiration?

Answer 42

Cough Wheeze ↓Air Entry URI Pneumonia

Question 43

What is the preferred method of Induction for a pt w/ an Airway Obstruction?

Answer 43

Gas Induction w/ Spont. Ventilation Avoid NMBs & Positive Pressure Ventilation

Question 44

What are complications of Foreign Body Aspiration?

Answer 44

Airway Obstruction Fragmentation of Object Arterial Hypoxemia Hypercarbia Subglottic Edema