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Summer 2020 - Advanced Anesthesia - Pediatrics > Pediatric Respiratory A&P & PeriOperative Considerations - Quiz 2 > Flashcards

Pediatric Respiratory A&P & PeriOperative Considerations - Quiz 2 Flashcards

1
Q

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

A

Explain Induction Steps

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2
Q

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

A

Anesthesia History

Premature Birth - Lung Problems

Developmental Delays

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3
Q

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

A

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

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4
Q

What can be used to Pre-Medicate Pediatric patients?

A

TLC

Distractions

Versed

Fentanyl/Morphine

Ketamine

Clonidine

Precedex

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5
Q

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

A

Pulse Ox –> EKG –> BP Cuff

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6
Q

What is the 1st stage of Anesthesia?

A

Awake

&

Eyes Midline

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7
Q

What is the 2nd stage of Anesthesia?

A

Hyper-Excitable

&

Eyes Divergent

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8
Q

What is the 3rd Stage of Anesthesia?

A

Asleep

&

Eyes Midline

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9
Q

What is the 4th Stage of Anesthesia?

A

Anesthetized CV Reflexes - Bradycardia & Hypotension

&

Eyes Midline

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10
Q

What makes IV Induction advantageous over Gas Induction?

A

Asleep w/o goin thru Stage 2 of Anesthesia

&

Low Laryngospasm Risk

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11
Q

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

A

Cricoid Cartilage - Narrowest Part & Cone-Shaped

Longer & Narrower Epiglottis w/ more Acute Angle

Shorter Neck

Larger Head, Occiput, Tongue, & Adenoids

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12
Q

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

A

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

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13
Q

What makes a Mainstem Intubation more likely in Pediatrics?

A

Short Trachea & Bronchus

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14
Q

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

A

Decadron & Zofran for kids > 1 yo

&

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

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15
Q

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

A

Tachycardia - Excitement, Fear, Pain

&

Hypotension in Older Kids/Teens

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16
Q

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

A

Stage 2 of Anesthesia - Excitement - Laryngospams

Extubate/Remove LMA Deep

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

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17
Q

How do Fatigued children affect the Anesthetic Plan?

A

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

&

Narcan 0.5 mcg/kg

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18
Q

What med is given for PONV in Pediatrics?

A

Zofran 0.1 - 0.5 mg/kg

19
Q

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

A

Hunger

20
Q

When do teeth erupt & shedding begin?

A

Teeth @ 6 Months

Shedding & 6-8yrs

21
Q

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

A

Omega-Shaped

22
Q

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

A

Lower Airways

23
Q

What happens if an Infant’s Nares are occluded?

A

Complete Airway Obstruction

24
Q

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

A

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

25
Q

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

A

9 Months: 50% from Ribcage

12 Months: Stable Chest Wall & Resists Inward Lung Recoill

26
Q

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

A

Infants consume 2-3x more Oxygen

27
Q

How is the ETT Size for a kid determined?

A

Uncuffed: [Age + 16] / 4

Cuffed: 1/2 size smaller

28
Q

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

A

15-25 cm H2O

29
Q

What is the Main cause of Post-Op Croup?

A

ETT too big

30
Q

Contraction of which Adductor Muscles results in Laryngospasms?

A

Lateral Cricoarytenoids

Thyroarytenoids

Cricoarytenoids

31
Q

What are the causes of Laryngospasms?

A

Volatile Agents

Excessive Secretions

URI

Airway Manipulation

Visceral Nerve Stimulation in the Pelvis, Abdomen, & Thorax

32
Q

How are Laryngospasms treated?

A

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

33
Q

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

A

Laryngeal Edema d/t trauma or ETT too tight

34
Q

How can Laryngeal Edema be treated?

A

Humidified Gas

Racemic Epi

Re-Intubation

Trach

35
Q

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

A

Epiglottitis - affects epiglottis and up

36
Q

What are symptoms of Epiglottitis?

A

Fast Progressing

Dysphagia

Dysphonia

Drooling

Stridor

High Fever

37
Q

What is the Treatment for Epiglottitis?

A

O2

Urgent Intubation - under GA & in the OR w/ ENT

ABX

Antipyretics

Fluids

38
Q

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

A

1.5 x smaller than normal

39
Q

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

A

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

40
Q

What are symptoms of Laryngotracheobronchitis?

A

Gradual Progression - 24-72 hours

URI progressing to Hoarse Cry/Barking Cough

Low Grade Fever

41
Q

How is Laryngotracheobronchitis treated?

A

O2 w/ Cool Mist

Racemic Epi

Corticosteroids

Antipyretics

Intubation is RARE

42
Q

What are symptoms of Foreign Body Aspiration?

A

Cough

Wheeze

↓Air Entry

URI

Pneumonia

43
Q

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

A

Gas Induction w/ Spont. Ventilation

Avoid NMBs & Positive Pressure Ventilation

44
Q

What are complications of Foreign Body Aspiration?

A

Airway Obstruction

Fragmentation of Object

Arterial Hypoxemia

Hypercarbia

Subglottic Edema

Summer 2020 - Advanced Anesthesia - Pediatrics (6 decks)

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