Pediatrics - Basics Flashcards
What is definition of a neonate?
0-31 days old
What is age of a infant?
1 month old - 1 year old
What is the definition in age of a child?
> 1 year old
What are some of major differences in adults and pediatrics?
- Body temp regulation
- Airways
- Respiratory
- NPO Guidelines
- Cardiovascular
Hypothermia causes what?
- Decreased wound healing
- Prolonged drug metabolism
- Increased coagulopathy
How do neonates regulate temperature?
Brown fat metabolism
Why causes hypothermia in pediatrics?
- Low body fat content
- Thin skin
- Increased BSA : mass ratio compared to adults
- Inability to shiver (neonates)
What does increased BSA: mass ratio mean?
Means there is more space to lose heat more quickly
What causes hyperthermia in pediatrics?
Malignant hyperthermia
What are 3 stages of losing heat under anesthesia?
1) A. internal redistribution of heat (very dramatic in peds)
2) B. heat loss to environment
3) C. rewarming (can occur quickly in peds)
What do you have to remember about evaluating pediatric airway?
- May not be able to perform in pre-op
- - May have to wait until versed has kicked in/started working
T or F:
Almost all pediatric codes are due to cardiac origin?
FALSE
most due to respiratory origin
T or F:
Majority of cardiopulmonary arrests occur at age < 1 year old
TRUE
What are anatomical differences for pediatric airway?
- Larger head, tongue, tonsils, adenoids
- Anterior and cephalad (higher) larynx
- Funnel shaped larynx
- Angled vocal cords in relation to trachea
What are anatomical differences for pediatric epiglottis?
- Long floppy epiglottis
- Omega shaped epiglottis
- Angled epiglottis away from axis of trachea
What is narrowest point in pediatric airway?
Cricoid ring
What is narrowest point in adult airway?
Vocal cords
At what age does obligate nasal breathing subside in pediatric population?
3-5 months
At what vertebra level is pediatric glottic opening?
Between C3-C4
At what vertebra level is preterm infant glottic opening?
C3
At what vertebra level is adult glottic opening?
Between C4-C5
What kind of blade do you use in peds?
Preceptor preference
Miller can be used better for lifting floppy epiglottis in neonates, infants and very young children
– But have both blades out to use
What kind of tube do you use in peds?
Attending preference
Can use cuffed, or uncuffed, or micro cuffed tubes
How much air can be placed into micro cuffed tube balloon?
0.25 - 1.5 mL
How do you determine size of tube to use?
Diameter = 4 + (age/4)
How do you determine depth of tube in the patient?
Depth = 12 + (age/2)
this only gives a ballpark depth, must tape at where you hear bilateral sounds
At what age can you start using the formula for determining the size of tube to use?
> 1 year old
What is the starting size of the tube for children?
4.0 tube
What is the starting size tube for neonates/infants?
3.5 tube
When performing the leak test, when should you hear the leak in a properly sized tube?
15-25 cmH2O
When performing the leak test, when should you hear the leak in a tube that is too small?
Leaks below 15 cmH2O
When performing the leak test, when should you hear the leak in a tube that is too large?
Leaks above 25 cmH2O
The physiology effect of edema basically means edema is what in pediatrics?
Detrimental
Any edema formation in pediatrics is very bad because they already have a narrower range to pass air through because trachea smaller in diameter so any blockage of this will greatly increase resistance and blockage compared to same edema formation in an adult
For a short case in pediatrics when using a size 4.0 tube or greater, should you use cuff or uncuffed?
Does not matter because of length of case
When are cuffed tubes then indicated?
- High aspiration risks cases (bowel obstruction)
- Low lung compliances cases (ARDS, CO2 insufflation cases)
- When needing precise control of ventilation and pCO2 gradients (Neuro cases, 1 ventricle physiology)
What are 2 main complications of ETT use in pediatrics?
– Postintubation croup ( can occur with multiple intubation attempts, traumatic intubation, large ETT used)
– Laryngotracheal stenosis (occurs in 90% of prolonged intubations and is caused by ischemic injury)
What is normal FRC for pediatric?
Same as adult
~ 28-30 mL/kg
What is main difference in respiratory development of adults and pediatrics?
- Lungs less compliant
- Chest wall more compliant
- Peds can be difficult to ventilate beacause of less efficient ventilation
- Peds have limited O2 reserve during apnea because of increased O2 demand
What is one of the last organs to develop in the fetus or premie?
Lungs
What is the O2 consumption demand of a infant?
6 mL/ kg/ min
adults are around 3 mL/ kg/ min
Are chemoreceptors in lungs developed in the term newborn enough that hypercarbia will cause ventilation?
TRUE
What do you have to watch out for in infants who are breathing during anesthesia on their own?
Infants fatigue rapidly
baby will work really hard to breath for a little while then will tire and not breath at all
Hypoxia will cause what to newborn infants up until 3 weeks old?
– Hypoxemia causes a transient increase in ventilation followed by a sustained depression
Hypoxia will cause what to infants 3 weeks old and older?
Hypoxemia induces sustained hyperventilation
What is the full term infant in weeks?
40 weeks
What is the premature infant in weeks?
< 37 weeks
What does hypercapnia cause in newborns?
Increased ventilation, but at a much lower rate progression
At what age do surfactant levels become adequate enough in infants?
34 weeks
General rules with peds, if kid is not running a fever and not producing phlegm
Proceed with surgery
General rules with peds, if kid has a productive cough
Delay surgery
What are signs of respiratory failure in peds?
- Increased work of breathing
- Tachypnea / tachycardia
- Wheezing
- Stridor
- Diaphoresis (sweating)
- Nasal flaring
How is the high O2 consumption infants require need met?
Increased RR
In general, what is different about peds cardiovascular development?
- Less contractile tissue
- Less compliant ventricles
- HEART RATE DEPENDENT
What 2 main things are found in the heart in fetal circulation that are not found in the adult?
- Patent ductus arteriosus
- - Patent foramen ovale
When does the PDA and foramen ovale usually close?
4-6 weeks old
What is normal fetal hemoglobin range in a neonate?
15-20 g / dL
When does fetal hemoglobin being to change to regular hemoglobin?
~ 3 months old
What is blood volume of adult male?
70-75 mL/ kg
What is blood volume of adult female?
60-65 mL/kg
What is blood volume of premie?
90-100 mL/kg
What is blood volume of full-term neonate?
80-90 mL/kg
What is blood volume of 12 mo infant?
75-80 mL/kg
What are normal vital signs for a neonate?
RR = 40
HR = 140
Sys BP = 65
Dia BP = 40
What are normal vital signs for a 12 month infant?
RR = 30
HR = 120
Sys BP = 95
Dia BP = 65
What are normal vital signs for a 3 years old?
RR = 25
HR = 100
Sys BP = 100
Dia BP = 70
What are normal vital signs for a 12 years old?
RR = 20
HR = 80
Sys BP = 110
Dia BP = 60
What are 2 rescue drugs to remember in peds?
- Atropine
- - Succinylcholine
What is peds dose of atropine?
0.01-0.02 mg/kg
What is peds dose of succinylcholine?
2 mg/kg
What is peds dose of versed ?
- 5 mg/kg PO
0. 1 mg/kg IV
What is peds dose of zofran ?
0.1 mg/kg
What is peds dose of ancef ?
25-50 mg/kg
What is fasting guidelines for a infant < 6 months old?
Solids, milk, formula : 4 hours
Clear liquids: 2 hours
What is fasting guidelines for a child 6 months old til 3 years old?
Solids, milk, formula : 6 hours
Clear liquids: 2-3 hours
What is fasting guidelines for a child >3 years old?
Solids, milk, formula : 8 hours
Clear liquids: 2-3 hours
What kind of induction is usually performed with kids?
Inhalational
What are risks of an inhalational induction?
- No protected airway
- - No IV
Who has the highest MAC requirements?
1-6 months old
usually 3 months old said to have highest
What is the rule of thumb for caudal blocks?
Can be given to kids younger than 7 years old or less than 30 kg
What is a caudal block?
1 time shot similar to spinal but done so much lower (around fusion of sacrum) with both a motor and sensory blockade
How are caudal blocks dosed?
BY VOLUME injected (NOT concentration)
What is normal caudal block dosage?
0.05 mL/ kg / dermatone level
For a general circumcision, how much local will be injected into a caudal block?
0.5 mL / dermatone
For a general umbilical cord repair, how much local will be injected into a caudal block?
0.75 mL / dermatone
When do most cardiac arrests occur in children?
During induction
What are some factors that will preclude a cardiac arrest?
- Bradycardia
- Low SpO2
- Hypotension
What are common causes of arrest in peds?
= Laryngospasm
= Difficult intubation
What are 2 predictors of mortality in the pediatric population?
ASA class 3-5 Emergency status
Infants <1 year old accounted for much of all arrests?
55%
Why are premature infants so prone to respiratory distress syndrome ?
Because of insufficient surfactant
When is extrauterine life possible ?
24-25 weeks gestation
What drug do you pre-med with in asthma patients?
Decadron = 0.2-0.5 mg/kg
WIth down syndrome patients, what must you do in your tube calculation?
Once you calculate tube size, downsize by 1/2 and use that tube
To avoid a sickle cell attack/crisis, what must you do to your patient?
- Keep em warm
- Keep em hydrated
- Treat pain aggressively
