Pediatrics Flashcards
Definitions of neonate, infant, and child
Neonate: Birth to 30 days
Infant: 1 month to 1 year
Child: 1 - 12 years
Kids develop similar physiology to an adult by age
8 years
Premature is considered < ____ weeks
37
Fetal transition to neonatal physiology takes place during the first ___-___ hours
24-72
Ductus arteriosus closure
Anatomic closure: 2-6 weeks High O2 can help it close
Foramen ovale closure
Functionally: rapid closure
Anatomically: 3 months
CV differences in kids
- Noncompliant LV - limited ability to handle increase in fluid volume or increase SV
- HR Dependent- only able to increase CO by increasing HR (this means that BP depends on HR as well)
- Limited catecholamine stores - May give atropine prophylactically
- Fetal circulation considerations - Cold, hypoxia, and hypercarbia can re-open these shunts
- Higher metabolic O2 demand than adults (because they are growing so rapidly!)
Pulmonary differences in kids
- Increased O2 consumption
- TV and dead space same as adults (dependent on rate for adequate MV for needed O2 demand)
- Resp rate is 2-3x that of adults
- Increased chest wall compliance
- Decreased lung compliance**
- SMALL DIAMETER AIRWAYS (increased resistance to flow)
- Hypoxia and hypercapnea will depress ventilation (compounds the problem!)
- Decreased Type 1 muscle fibers in diaphram (kid poops out quickly from high RR and poor lung compliance) Fewer alveoli Smaller FRC****
Unique airway differences in kids
- Narrow nasal passages (lean towards using oral airway)
- Obligate nasal breathing***** (
- until about 6 months, until then, make sure their nose is clear so they can breath!!!)
- Cricoid cartilage is most narrow portion of airway***
- Short neck, large head, large tongue
- Larynx is more cephalad (C4) and is funnel shaped
- Epiglottis is narrow and stubby
- VC attachment is angled anterior and caudad
- easier to place in wrong spot
- Smaller margin of error for R mainstem intubation
How should infants be positioned for intubation?
- Towel roll under shoulders b/c their heads are fucking huge. This should align things properly
- neck should be neutral or slightly flexed. Extreme flexion or extension will kink airway***
Just 1mm of airway edema can decrease cross-sectional area by ___%
Compared to how much in an adult?
75% in infant
44% in an adult
Fluid/Electrolyte differences in kids
- Higher total body water
- ECF = 40% of TBW in neonates and 20% of TBW in those over 2 years
- More ECF = more prone to dehydration
Kidney function reaches normal by __ months
6 months
Until this time, every week counts for kidney development!!
Hemoglobin levels in kids
- Hgb at birth = 18-20g/dL -
- Most of this is fetal Hgb and has a shift to the left!
- This helps to extract O2 from the mother.
- Low Hgb levels bad in newborn d/t shift to the left.
- Hgb pre-term = 13-15 g/dL
- Hgb at 2 months = 10-12 g/dL
- Lower threshold for transfusion
- Hgb at 6-24 months = 12 g/dL
- Hgb at 2-6 years = 12.5 g/dL
- Hgb at 6-12 years = 13.5 g/dL
- In newborn, blood loss >10-15% may not be tolerated Fetal Hgb
- Most kids though end up doing ok with low hgb. Always check with surgeon before giving blood to a kid.
Hepatic and GI differences in kids
- Low hepatic blood flow in first months of life
- CYP450 maturity has huge variability
- Type 1 reactions mature faster than Type 2 (conjugation) –> so avoid drugs that undergo type 2
- Low glycogen stores (worry about hypoglycemia!)
- Impaired conjugation –> jaundice
- Poor coordination with breathing and swallowing until 4-5 months (reflux is common!)
- Low plasma albumin levels
- impacts dosing of protein bound drugs
Kids can’t shiver until __ months
3 Until then, they rely on brown fat metabolism
Keeping kids warm is a huge priority** to avoid excessive O2 consumption
Thermoregulation
- Brown fat metabolism = high O2 consumption
- Thin skin
- Low fat content
- Large surface area
- Interventions: Warmed mattress, blankets, warm room, cover the head, humidify inspired gases, bair hugger
General rules about kids and E1/2t of drugs
- Infants: Prolonged E1/2t
- Children 2-12: Shortened E1/2t
- Reaching adulthood: Normal E1/2t
Highes to lowest MAC requirements
Infant (highest) >Neonate > Child > Adult (lowest)
Preemies tolerate IAs poorly. Use minimally or not at all.
When is it appropriate to give sux to a kid?
- RSI and laryngospasm
- Must give with atropine!
- Avoid second dose if possible (higher risk of bradycardia and arrest with second dose)
- Roc can be risky b/c it has a longer DOA if you have difficulty securing the airway
- (peds have lower FRC and higher O2 demand –> desat quickly)
NDMR dosing is kids
- Kids have a higher Vd, but also immature NMJ.
- This results in NDMR dosing similar to adults.
- Neostigmine dosing is slightly lower though (.02-.05mg/kg) NMJ matures around 2 months.
Why is adequate reversal critical in kids?
- Lower FRC and higher O2 demand
- (need proper lung functioning)
- Increased lung compliance
- MV dependent on RR
How to determine if tube is the correct size in a kid
- Check leak pressure
- If leak occurs at < 20 = too small
- If leak occurs btw 20-30 = just right I
- f leak occurs at 30-40 = too large
Reservoir bag size for peds
1-2L