Pediatrics Flashcards
Patient (peds) outcomes affected by
immaturity of organ systems
psychological
physical stress of surgery
effects of anesthetics
related pathology
Immaturity of ograns mostly significant until what age
2 yo
per therman
age of neonates
<30 days
infant age
1-12 months
preterm infant
born before 37 weeks
»Term infant:
born after 37 wks & before 42 wks
»Post term infant:
born after 42 wks
»Low birth weight:
< 2500 gms
•Regardless of gestational age
»Extremely low birth weight:
< 1000 gms
•Children: ___years of age
»Toddler: ___ years of age
»Preschool: ___ years of age
»School age: ___ years of age
•Children: 1-12 years of age
»Toddler: 1-3 years of age
»Preschool: 3-6 years of age
»School age: 6-13 years of age
•Adolescent: ___ years of age
•Adolescent: 13-18 years of age
contractile components of myocardium
sacroplasmic reticulum
t-tubule system
•Myocardium pepends on what for contractility
free ionized Ca++
•Capable of limited ↑ in SV
up to LA pressures of ___ mmHg
when afterload remains low
10-12
things that can increase afterload which leads to further decrease in cardiac output
acidosis
hypothermia
pain
CO depends on what
HR
2 things that cause
dec CO & organ perfusion threatened
hypovolemia + bradycardia
drug that increase contractility + inc HR
epi
HR
1st day of life:
1st month of age:
Adolescence:
1st day of life: 120
1st month of age: 160
Adolescence: 75-100
sleep HR lower than
100
HR inc up to __ with pain
200
predominant driver producing bradycardia with even minor clinical interventions (eg suctioning, laryngoscopy)
ANS causes HR variation
parasympathetic dominance
T wave upright due to
Right ventricular (RV) dominance
considered Hypotension in asnethetized
newborn
1 year old
other child
- newborn <60 mmHg
- 1 year old < 70
- other child SBP 70 + age(yrs)x2
calculation for child > 1 to determine if hypotension
70 + age*2
lowest BP “according to Barash chart”
- 0-3 mo
- 3-6 mo
- 6-12 mo
- 1-3 years
- 3-6 years
- 6-12 years
- >12 years
- 0-3 mo 65
- 3-6 mo 70
- 6-12 mo 80
- 1-3 years 90
- 3-6 years 95
- 6-12 years 100
- >12 years 110
Lowest BP “according to Nagelhout chart”
neonate
12 mo
3 years
12 years
neonate 70
12 mo 95
3 years 100
12 years 110
predominant hemoglobin species in neborn contributing to 70-90% of total
Fetal Hg
explain how/why the fetus is able to “exist” in such a low PaO2 environment in utero
O2 affinity
fetal Hg > Adult Hg
fascillitates O2 uptake thru placental circ.
lowest Hg during this age
3 months
nadir
bc of dec erythropoesis and dec life span of of newborns RBC
Review
- O2 rich environment p birth
- decreased erythroid activity, dec hematopoesis
- dec erythroposis + dec lifespan of newborn RBC
- –> lowest Hg by 3 months
- Physiologic Anemia of Infancy
- Does NOT compromise fetus bc RIGHT O2/hg/diss curve
- More released to tissue
- inc 2,3 DPG and inc Hemaglobin A (adult) replacing fetal 3-6 mo
Review
- O2 rich environment p birth
- decreased erythroid activity, dec hematopoesis
- dec erythroposis + dec lifespan of newborn RBC
- –> lowest Hg by 3 months
- Physiologic Anemia of Infancy
- Does NOT compromise fetus bc RIGHT O2/hg/diss curve
- More released to tissue
- inc 2,3 DPG and inc Hemaglobin A (adult) replacing fetal 3-6 mo
Vitamin K dependent clotting factors
which are 20-50% of adult levels
even lower in premature
II, VII, IX, X
2, 7, 9, 10
newborn’s blood volume depends on what
time of cord clamping
blood volume
immediate clamping < if clamping after placenta out
newborn EBV
80 - 90 ml/kg
% loss of IVF immediately/postnatal period
dec 25%
inc over next 2 months
peaks 2 months of age
EBV by age
- premature
- newborn
- infant 3 mo - 3 yo
- > 6 yo children
- adults
- premature 90-100
- newborn 80-90
- infant 3 mo - 3 yo 75 -80
- > 6 yo children 65-70
- adults 65-70
fetus able to sustain life what weeks of gestational age
24-26 weeks
•_____ million terminal sacs develop into alveoli after birth
10-20 mil
alveolar formation accelorates what age
12-18 mo postnatally
alveoli increase in # and SIZE until what age
8 yo
alveoli # btw 8-10 yo
200-300 million
•______ __ _______ - production & secretion of surfactant
Type II pneumocytes
surfactant (type II pneumocytes) begins at what wks and peaks
- Type II pneumocytes - production & secretion of surfactant
- Begins ~ 22-26 wk; Peaks ~ 35-36 wk gestation
explains relationship btw dec surface tension within the alveoli to decrease alveolar collapse
Law of Laplace
control of breathing depend on what 3 things
- PaO2
- PaCO2
- Ph - central chemoreceptors
- Inspiratory pause lasting 10 seconds followed by ↑ ventilation
- More common in premature
- Occurs more often during REM
•Periodic breathing:
