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SEE Stuff > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

Epiglottis

Organism

A

Bacterial:

  • H. Influenza
  • Group A strep
  • Pneumococci
  • Staphylococci
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2
Q

Epiglottis

Age

A

2-6 yr

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3
Q

Epiglottis

Onset

A

Rapid (<24hrs)

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4
Q

Epiglottis

Region affected

A

Supraglottic structures

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5
Q

Epiglottis

Lateral neck Xray

A

Swollen epiglottis (thumb sign)

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6
Q

Epiglottis

Clinical presentation

A

High fever
Tripod position
4Ds - drooling, dysphonia, dyspnea, dysphagia

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7
Q

Epiglottis

Treatment

A
  • O2
  • Urgent airway mangement - intubation/trach
  • ABX (if bacterial)
  • Induction with spontaneous ventilation (CPAP 10-15cm H2O minimizes airway collapse)
  • ENT surgeon must be present
  • Post-op ICU care
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8
Q

Laryngotracheobronchitis (croup)

Organism

A

Viral

  • H. parainfluenza
  • RSV
  • Influenza A & B
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9
Q

Laryngotracheobronchitis (croup)

Age

A

< 2 yr

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10
Q

Laryngotracheobronchitis (croup)

Onset

A

Gradual (24 - 72 hrs)

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11
Q

Laryngotracheobronchitis (croup)

Region affected

A

Laryngeal structures

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12
Q

Laryngotracheobronchitis (croup)

Lateral neck XRAY

A

Subglottic narrowing (steeple sign)

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13
Q

Laryngotracheobronchitis (croup)

Clinical presentation

A

Mild fever
Inspiratory stridor
Barking cough

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14
Q

Laryngotracheobronchitis (croup)

Treatment

A 
O2
Racemic epi
Corticosteroids
Humidification
Fluids
Intubation rarely required
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15
Q

Pathophysiology of postintubation laryngeal edema

A

AKA post intubation croup - complication of endotracheal intubation or rigid bronch

Tracheal mucosa perfusion pressure is 25cm H2O. Using an ETT that is too large or injecting an excessive amount of air into the cuff reduces tracheal perfusion -> edema -> decreases subglottic airway diameter -> increase WOB

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16
Q

Presentation of postintubation laryngeal edema

A

Pt presents with hoarseness, barky cough, and/or stridor

Typically occurs 30-60 min following extubation

17
Q

What are the risk factors for postintubation laryngeal edema?

A

Risk factors (all rom small airway or airway trauma)

  • Age <4
  • ETT is too large
  • ETT cuff volume too high
  • Traumatic or multiple intubation attempts
  • Prolonged intubation
  • Coughing while intubated
  • Head or neck surgery
  • Head repositioning during surgery
  • Hx of infection or post intubation croup
  • Trisomy 21
  • URI?
18
Q

Best way to minimize postintubation laryngeal edema

A

Best treatment is prevention!

Key point is to maintain an air leak < 25 cm H2O. If using cuffed ETT, use manometer intermittently to measure cuff pressure

19
Q

Treatment or postintubation laryngeal edema

A

Treatment aims at reducing swelling and improving laminar airflow:

  • Cool and humidified oxygen
  • Nebulized racemic epi 0.5 ml or 2.25% solution in 2.5 ml NACL
  • Decadron 0.25-0.5 mg/kg IV (effect in 4-6 hrs)
  • Heliox is a helium + oxygen mixture and improves laminar airflow by reducing Reynolds number

NOT infectious so no ABX

Observe pt for 4-6 hours after racemic epi

20
Q

A patient with a respiratory infection presents for a tonsillectomy. Which S/S favor postponing the procedure?

A

Proceed with caution:

  • Runny nose without other symptoms
  • Clear nasal drainage
  • No Fever
  • Active
  • Appears happy
  • Clear lungs
  • Older child

Reasons to CANCEL:

  • Purulent nasal drainage
  • Fever (>38 or 100.4)
  • Lethargic
  • Persistent cough
  • Poor appetite
  • Wheezing & rales that do not clear with cough
  • Child <1 or previous premie
21
Q

Hoe can you reduce the risk of airway complications while anesthetizing a child with an upper respiratory infection?

A
  • Avoid mechanical irritation of airway: Facemask > LMA&raquo_space;> ETT
  • Mechanical irritation (ETT) increases risk of bronchospasm 10-fold!
  • If ETT must be used, use smaller size than normal, at higher risk for post intubation croup
  • Dexamethasone 0.25-0.5 mg/kg will reduce risk of post-intubation croup
  • Ensure deep plane of anesthesia before instrumenting airway
  • Propofol attenuates airway reactivity and may reduce risk of bronchospasm
  • Sevo best = non-pungent
  • Pretreatment with inhaled bronchodilator or glycolic doe snot provide a clear benefit
22
Q

Describe presentation of child who presents with foreign body aspiration

A

Classic triad of cough, wheezing, a decreased breath sounds on affected side (usually right)

Airway obstruction significant enough to impair gas exchange can quickly progress to hypoxemia, cyanosis, lathered mental status, cardiac arrest and death

Supraglottic = Stridor (S/S)
Infraglottic = Wheezing
23
Q

What are the complications of rigid bronchoscopy?

A

Rigid branch is GOLD STANDARD for retrieval of foreign body

Complications:

  • Laryngospams
  • Bradycardia during scope insertion
  • Post-intubation croup
  • Pneumothorax
24
Q

Syndrome associates with difficult airway management

Large Tongue

A

“Big Tongue”

Beckwith syndrome
Trisomy 21

25
Q

Syndrome associates with difficult airway management

Small/Underdeveloped mandible

A

“Please Get That Chin”

Pierre Robin
Goldenhar
Treacher Collins
Cri du Chat

26
Q

Syndrome associates with difficult airway management

Cervical spine anomaly

A

“Kids TRY Gold”

Klippel-Feil
Trisomy 21
Goldenhar

27
Q

Describe the airway in a patient with trisomy 21

A

At risk for difficult intubation & ventilation

  • Small mouth
  • Large tongue
  • Palate narrow with high arch
  • Midface hypoplasia
  • Atlantoaxial instability (C1 & C2 subluxation - avoid neck flexion)
  • Subglottic stenosis (use smaller ETT)
  • Obstructive sleep apnea
  • Chronic pulmonary infection
28
Q

What is CHARGE association?

A 
C - Coloboma (hole in eye structure)
H - Heart defects
A - choanal Atresia
R - Retardation of growth &amp; development
G - Genitourinary problems
E - Ear anomalies
29
Q

What is CATCH - 22

A

AKA DiGeorge syndrome or 22q11.2 gene deletion syndrome

C - Cardiac defects
A - Abnormal face
T - Thymic hypoplasia
C - Cleft palate
H - Hypocalcemia (d/y hypoparathyroidism)
22 - 22q11.2 gene deletion (cause of syndrome)

30
Q

What are the unique anesthetic considerations for the patient with DiGeorge syndrome?

A

Hypokalemia is common (remember hyperventilation, albumin, and citrated blood products lower free Ca +2 in the blood)

If the thymus is absent, the child is at high risk for infection. Treatment consists of thymus transplant or mature T cell infusion. Transfusion of leukocyte-depleated irradiated blood is best.

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