Pediatrics Flashcards
What are the usual doses of common pain medications in children?
acetaminophen: 12.5 mg/kg
ketorolac: 0.5 mg/kg
fentanyl: 1-2 mcg/kg
morphine: 0.05 mg/kg
What are the usual doses of common induction agents in children?
midazolam: 0.1 mg/kg IV, 1 mg/kg PO
propofol: 2-4 mg/kg
ketamine: 2 mg/kg IV, 4 mg/kg IM
succinylcholine: 1-2 mg/kg IV, 2-4 mg/kg IM
atropine (pre-med): 0.01-0.02 mg/kg IV/IM
What are the usual doses of common ACLS medications in children?
epinephrine: 0.01 mg/kg
atropine: 0.02 mg/kg
What is the most common type of EA/TEF?
a blind esophageal pouch and a fistula linking the distal esophagus to the trachea
What syndrome is associated with EA/TEF?
VACTERL
vertebral anomalies
anal canal defects
cardiac abnormalities
TEF
renal dysplasia
limb defects
What is the risk of placing a gastrostomy in a patient with EA/TEF?
inhaled gas can bypass the lungs and exit through the trachea (especially if lung compliance is poor)
If an infant with EA/TEF cannot be ventilated, what are the salvage options?
emergency ligation through an abdominal or thoracic approach
placement of a ballon catheter through a gastrostmy and inflated to occlude the fistula
What are the options for ETT position during EA/TEF repair?
below the fistula but above the carina
if fistula is small, above the fistula with low ventilation pressures
Where are most congenital diaphragmatic hernias?
85% on the left, through the foramen of Bochdalek
Why are babies with CDH hypoxemic?
less ventilation (low lung compliance)
less surface area for gas exchange (fewer alveoli)
R-to-L shunting through the PDA (pulmonary HTN)
How should a baby with CDH be managed immediately after birth?
NO MASK VENTILATION
intubation
OG tube for stomach decompression
Is CDH a surgical emergency?
no
hemodynamics, respiratory support, and acid/base status should be optimized first
What are the likely causes of abrupt hypotension, hypoxia, and bradycardia after CDH repair?
tension pneumothorax (usually contralateral to the repair)
IVC compression (undersized peritoneal cavity)
Discuss pediatric fluid management.
maintenance fluids: 5% dextrose in 1/2 NS at 4 mL/kg/hr
insensible losses: LR or NS 6-8 mL/kg/hr
blood loss: 3 mL LR or 1 mL albumin/1 mL EBL
What are the components of Tetralogy of Fallot?
RV outflow obstruction
RV hypertrophy
large VSD
overriding aorta
What is the QP:QS ratio for maximal oxygen delivery?
1:1
What are the principles of treating a “Tet spell?”
give 100% O2
increase SVR to reduce the R-to-L shunt (squat, treat metabolic acidosis, give phenylephrine)
increase preload (fluids, beta blockers)
When is full correction of TOF done? What does it entail?
between 2-10 months
relieving RV outflow obstruction, VSD closure, shunt ligation
How can a patent ductus arteriosus be maintained? Closed?
maintained: prostaglandin E1
closed: indomethacin
What are the most common connection between the pulmonary and systemic circulation in transposition of the great arteries?
PDA and PFO
What are the metabolic derangements associated with pyloric stenosis?
early: hypokalemic, hypochloremic metabolic alkalosis
late: metabolic acidosis due to hypovolemic shock
What are usual ETT sizes?
newborn: 3.0
6 months: 3.5
12 months: 4.0
older: 4 + age/4
What are the components of treating post-extubation croup?
humidified supplemental oxygen
racemic epinephrine
steroids (delayed action)
How does stridor correlate with the location of obstruction?
inspiratory: supraglottic or laryngeal
expiratory: intrathoracic
biphasic: laryngeal and subglottic
How would you induce anesthesia in a child with epiglottitis?
AVOID AGITATION AND CRYING
inhalational induction
careful laryngoscopy
muscle relaxant only after successful mask ventilation
What abnormalities are associated with DiGeorge syndrome?
CATCH-22
cardiac defects
abnormal facies
thymic aplasia
cleft palate
hypocalcemia
