Pediatrics Flashcards
Compared to epiglottitis, which findings are MORE likely to occur with laryngotracheobronchitis? (select 3)
a. age affected <2 years
b. high fever
c. tripod position
d. steeple sign
e. onset between 24-72 hours
f. more likely to require anesthesia for urgent airway control
a. age affected <2 years
d. steeple sign
e. onset between 24-72 hours
Epiglottitis is _______ in nature.
bacterial
Epiglottitis affects ages ________
2-6 yrs
Epiglottitis is a _______ onset
rapid
Clinical presentation of epiglottitis includes
the 4 D’s: drooling, dyspnea, dysphonia, dysphagia, & high fever
tripod position
Treatment of epiglottitis includes
O2
urgent airway management antibiotics
With epiglottitis, _______ must be present for induction
ENT
Laryngeotracheobronchitis is otherwise known as
croup
Croup is _________ in nature
viral
Croup affects ages __________
<2 yrs
The onset of croup is
gradual
Clinical presentation of croup includes
mild fever
inspiratory stridor
barking cough
retractions- suprasternal, substernal, or intercostal
Croup should be treated with
O2
racemic epi
steroids
humidification
and fluids
________ is rarely required with croup
Intubation
The region affected with epiglottitis includes
supraglottic structures: epiglottis, vallecula, arytenoids, aryepiglottic folds
The region affected with croup includes
laryngeal structures below the vocal cords
Describe the neck XR of epiglottis
Thumb sign (lateral XR)
Describe the neck XR of croup
Steeple sign (frontal XR)
When diluted into 2.5 mL of 0.9% sodium chloride, what is the most appropriate dose of racemic epinephrine to administer to a 30-kg child with postintubation croup?
a. 0.5 mL of 0.25% solution
b. 0.5 mL of 2.25% solution
c. 5 mL of a 0.25% solution
d. 5 mL of a 2.25% solution
b. 0.5 mL of a 2.25% solution
Post-intubation laryngeal edema can occur with
cuffed or uncuffed endotracheal tubes
_________ should be maintained to prevent post-intubation laryngeal edema
air leak <25 cmH2O
If you are using a cuffed ETT, then you should use a ______ to measure cuff pressure intermittently.
manometer
Risk factors for postintubation laryngeal edema
using an ETT that is too large (most common)
age <4 (more common in small children)
cuff pressure too high
prolonged intubation
trauma due to multiple intubating attempts
coughing (cuff rubs against trachea mucosa)
head or neck surgery
head repositioning during surgery
trisomy 21
history of infectious or post-intubation croup
Treatment for postintubation laryngeal edema includes
cool and humidified O2
dexamethasone
racemic epinephrine
heliox
The patient with post-intubation laryngeal edema presents with
hoarseness
a barky cough
stridor
__________ is the preferred treatment for post-intubation laryngeal edema to reduce welling and improve airflow
Racemic epinephrine
What is the volume of 2.25% racemic epinephrine for children 0-20 kg?
0.25 mLs
(diluted with 2.5 mLs)
What is the volume of 2.25% racemic epinephirne for children 20-40 kg?
0.5 mLs (diluted with 2.5 mls)
What is the volume of 2.25% racemic epinephrine for children >40 kg?
0.75 mLs (diluted with 2.5 mLs)
The patient should be observed for a minimum of ___________ after the racemic epinephrine treatment is complete
four hours
A five year old child presents with surgery with clear rhinorrhea, but she is afebrile and appears active. Rank the following airway techniques from MOST to LEAST favorable to minimize the risk of airway reactivity.
LMA
Endotracheal tube
facemask
Facemask
LMA
Endotracheal tube
A child with an active or recent history of upper respiratory tract infection is
at an increased risk of pulmonary complications
Most clinicians _____________ after the onset of URI symtpoms
postpone the procedure for 2-4 weeks
Reasons to cancel surgery for upper respiratory infection include
purulent nasal discharge
temperature >38.0 C
lethargy
persistent cough
poor appetite
wheezing and rales that don’t clear with a cough
Methods to reduce the risk of pulmonary complications in a child with a recent upper respiratory infection include:
avoid mechanical irritation of the airway (facemask>LMA»»ETT)
If an ETT is used, use a smaller size than normal
Decadron 0.25-0.5 mg/kg will reduce the risk of post-intubation croup
propofol attenuates airway reactivity and may reduce the risk of bronchospasm
__________ is the best volatile agent with an URI
sevoflurane
Pretreatment with an inhaled bronchodilator or glycopyrrolate for URI
does not provide a clear benefit
A child with an active history or recent history of URI is more likely to
bronchospasm
mucous plug
laryngospasm
have atelectasis
desaturation events
postoperative hypoxemia
For a patient with URI___________ should be ensured before instrumenting the airway
a deep plane of anesthesia
A 3-year-old child aspirated a peanut and presents for rigid bronchoscopy. What is the MOST important anesthetic consideration for this patient?
a. inhalation induction
b. observing NPO guidelines
c. positive pressure ventilation
d. rocuronium
a. inhalation induction
Over 60% of children with foreign body aspiration present with
the classic triad of cough, wheezing, and decreased breath sounds on the affected side (usually the right)
A supraglottic obstruction presents with
stridor
A subglottic obstruction presents with
wheezing
__________ is the “gold standard” procedure to retrieve the foreign body from the airway
Rigid bronchoscopy
What is the best anesthetic for a foreign body aspiration?
sevoflurane induction with spontaneous ventilation
TIVA is probably the best maintenance
If the patient with a foreign body aspirate coughs or bucks, the
foreign body can move distally
__________ can push the foreign body deeper into the bronchial tree
positive pressure ventilation
A foreign body most commonly lodges in the
right bronchus
Complications of rigid bronchoscopy include
laryngospasm
bradycardia during scope insertion
pneumothorax
post-intubation croup
patients may not improve immediately after the foreign body is removed due to residual lung inflammation
Alternatives to rigid bronchoscopy for foreign body aspiration include
flexible bronchoscopy or thoracotomy
________ is a concern when using a rigid bronchosope.
Some degree of air leak which can dilute concentration of volatile anesthetic (turn up FGF and vaporizer output)
