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AP Summer > Pediatrics - Basics > Flashcards

Pediatrics - Basics Flashcards

1
Q

What is definition of a neonate?

A

0-31 days old

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2
Q

What is age of a infant?

A

1 month old - 1 year old

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3
Q

What is the definition in age of a child?

A

> 1 year old

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4
Q

What are some of major differences in adults and pediatrics?

A
    • Body temp regulation
    • Airways
    • Respiratory
    • NPO Guidelines
    • Cardiovascular
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5
Q

Hypothermia causes what?

A
    • Decreased wound healing
    • Prolonged drug metabolism
    • Increased coagulopathy
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6
Q

How do neonates regulate temperature?

A

Brown fat metabolism

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7
Q

Why causes hypothermia in pediatrics?

A
    • Low body fat content
    • Thin skin
    • Increased BSA : mass ratio compared to adults
    • Inability to shiver (neonates)
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8
Q

What does increased BSA: mass ratio mean?

A

Means there is more space to lose heat more quickly

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9
Q

What causes hyperthermia in pediatrics?

A

Malignant hyperthermia

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10
Q

What are 3 stages of losing heat under anesthesia?

A

1) A. internal redistribution of heat (very dramatic in peds)
2) B. heat loss to environment
3) C. rewarming (can occur quickly in peds)

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11
Q

What do you have to remember about evaluating pediatric airway?

A
    • May not be able to perform in pre-op

- - May have to wait until versed has kicked in/started working

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12
Q

T or F:

Almost all pediatric codes are due to cardiac origin?

A

FALSE

most due to respiratory origin

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13
Q

T or F:

Majority of cardiopulmonary arrests occur at age < 1 year old

A

TRUE

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14
Q

What are anatomical differences for pediatric airway?

A
    • Larger head, tongue, tonsils, adenoids
    • Anterior and cephalad (higher) larynx
    • Funnel shaped larynx
    • Angled vocal cords in relation to trachea
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15
Q

What are anatomical differences for pediatric epiglottis?

A
    • Long floppy epiglottis
    • Omega shaped epiglottis
    • Angled epiglottis away from axis of trachea
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16
Q

What is narrowest point in pediatric airway?

A

Cricoid ring

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17
Q

What is narrowest point in adult airway?

A

Vocal cords

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18
Q

At what age does obligate nasal breathing subside in pediatric population?

A

3-5 months

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19
Q

At what vertebra level is pediatric glottic opening?

A

Between C3-C4

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20
Q

At what vertebra level is preterm infant glottic opening?

A

C3

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21
Q

At what vertebra level is adult glottic opening?

A

Between C4-C5

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22
Q

What kind of blade do you use in peds?

A

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

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23
Q

What kind of tube do you use in peds?

A

Attending preference

Can use cuffed, or uncuffed, or micro cuffed tubes

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24
Q

How much air can be placed into micro cuffed tube balloon?

A

0.25 - 1.5 mL

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25
Q

How do you determine size of tube to use?

A

Diameter = 4 + (age/4)

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26
Q

How do you determine depth of tube in the patient?

A

Depth = 12 + (age/2)

this only gives a ballpark depth, must tape at where you hear bilateral sounds

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27
Q

At what age can you start using the formula for determining the size of tube to use?

A

> 1 year old

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28
Q

What is the starting size of the tube for children?

A

4.0 tube

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29
Q

What is the starting size tube for neonates/infants?

A

3.5 tube

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30
Q

When performing the leak test, when should you hear the leak in a properly sized tube?

A

15-25 cmH2O

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31
Q

When performing the leak test, when should you hear the leak in a tube that is too small?

A

Leaks below 15 cmH2O

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32
Q

When performing the leak test, when should you hear the leak in a tube that is too large?

A

Leaks above 25 cmH2O

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33
Q

The physiology effect of edema basically means edema is what in pediatrics?

A

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

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34
Q

For a short case in pediatrics when using a size 4.0 tube or greater, should you use cuff or uncuffed?

A

Does not matter because of length of case

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35
Q

When are cuffed tubes then indicated?

A
    • 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)
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36
Q

What are 2 main complications of ETT use in pediatrics?

A

– 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)

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37
Q

What is normal FRC for pediatric?

A

Same as adult

~ 28-30 mL/kg

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38
Q

What is main difference in respiratory development of adults and pediatrics?

A
    • 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
39
Q

What is one of the last organs to develop in the fetus or premie?

A

Lungs

40
Q

What is the O2 consumption demand of a infant?

A

6 mL/ kg/ min

adults are around 3 mL/ kg/ min

41
Q

Are chemoreceptors in lungs developed in the term newborn enough that hypercarbia will cause ventilation?

A

TRUE

42
Q

What do you have to watch out for in infants who are breathing during anesthesia on their own?

A

Infants fatigue rapidly

baby will work really hard to breath for a little while then will tire and not breath at all

43
Q

Hypoxia will cause what to newborn infants up until 3 weeks old?

A

– Hypoxemia causes a transient increase in ventilation followed by a sustained depression

44
Q

Hypoxia will cause what to infants 3 weeks old and older?

A

Hypoxemia induces sustained hyperventilation

45
Q

What is the full term infant in weeks?

A

40 weeks

46
Q

What is the premature infant in weeks?

A

< 37 weeks

47
Q

What does hypercapnia cause in newborns?

A

Increased ventilation, but at a much lower rate progression

48
Q

At what age do surfactant levels become adequate enough in infants?

A

34 weeks

49
Q

General rules with peds, if kid is not running a fever and not producing phlegm

A

Proceed with surgery

50
Q

General rules with peds, if kid has a productive cough

A

Delay surgery

51
Q

What are signs of respiratory failure in peds?

A
    • Increased work of breathing
    • Tachypnea / tachycardia
    • Wheezing
    • Stridor
    • Diaphoresis (sweating)
    • Nasal flaring
52
Q

How is the high O2 consumption infants require need met?

A

Increased RR

53
Q

In general, what is different about peds cardiovascular development?

A
    • Less contractile tissue
    • Less compliant ventricles
    • HEART RATE DEPENDENT
54
Q

What 2 main things are found in the heart in fetal circulation that are not found in the adult?

A
    • Patent ductus arteriosus

- - Patent foramen ovale

55
Q

When does the PDA and foramen ovale usually close?

A

4-6 weeks old

56
Q

What is normal fetal hemoglobin range in a neonate?

A

15-20 g / dL

57
Q

When does fetal hemoglobin being to change to regular hemoglobin?

A

~ 3 months old

58
Q

What is blood volume of adult male?

A

70-75 mL/ kg

59
Q

What is blood volume of adult female?

A

60-65 mL/kg

60
Q

What is blood volume of premie?

A

90-100 mL/kg

61
Q

What is blood volume of full-term neonate?

A

80-90 mL/kg

62
Q

What is blood volume of 12 mo infant?

A

75-80 mL/kg

63
Q

What are normal vital signs for a neonate?

A

RR = 40
HR = 140
Sys BP = 65
Dia BP = 40

64
Q

What are normal vital signs for a 12 month infant?

A

RR = 30
HR = 120
Sys BP = 95
Dia BP = 65

65
Q

What are normal vital signs for a 3 years old?

A

RR = 25
HR = 100
Sys BP = 100
Dia BP = 70

66
Q

What are normal vital signs for a 12 years old?

A

RR = 20
HR = 80
Sys BP = 110
Dia BP = 60

67
Q

What are 2 rescue drugs to remember in peds?

A
    • Atropine

- - Succinylcholine

68
Q

What is peds dose of atropine?

A

0.01-0.02 mg/kg

69
Q

What is peds dose of succinylcholine?

A

2 mg/kg

70
Q

What is peds dose of versed ?

A
  1. 5 mg/kg PO

0. 1 mg/kg IV

71
Q

What is peds dose of zofran ?

A

0.1 mg/kg

72
Q

What is peds dose of ancef ?

A

25-50 mg/kg

73
Q

What is fasting guidelines for a infant < 6 months old?

A

Solids, milk, formula : 4 hours

Clear liquids: 2 hours

74
Q

What is fasting guidelines for a child 6 months old til 3 years old?

A

Solids, milk, formula : 6 hours

Clear liquids: 2-3 hours

75
Q

What is fasting guidelines for a child >3 years old?

A

Solids, milk, formula : 8 hours

Clear liquids: 2-3 hours

76
Q

What kind of induction is usually performed with kids?

A

Inhalational

77
Q

What are risks of an inhalational induction?

A
    • No protected airway

- - No IV

78
Q

Who has the highest MAC requirements?

A

1-6 months old

usually 3 months old said to have highest

79
Q

What is the rule of thumb for caudal blocks?

A

Can be given to kids younger than 7 years old or less than 30 kg

80
Q

What is a caudal block?

A

1 time shot similar to spinal but done so much lower (around fusion of sacrum) with both a motor and sensory blockade

81
Q

How are caudal blocks dosed?

A

BY VOLUME injected (NOT concentration)

82
Q

What is normal caudal block dosage?

A

0.05 mL/ kg / dermatone level

83
Q

For a general circumcision, how much local will be injected into a caudal block?

A

0.5 mL / dermatone

84
Q

For a general umbilical cord repair, how much local will be injected into a caudal block?

A

0.75 mL / dermatone

85
Q

When do most cardiac arrests occur in children?

A

During induction

86
Q

What are some factors that will preclude a cardiac arrest?

A
    • Bradycardia
    • Low SpO2
    • Hypotension
87
Q

What are common causes of arrest in peds?

A

= Laryngospasm

= Difficult intubation

88
Q

What are 2 predictors of mortality in the pediatric population?

A 
ASA class 3-5
Emergency status
89
Q

Infants <1 year old accounted for much of all arrests?

A

55%

90
Q

Why are premature infants so prone to respiratory distress syndrome ?

A

Because of insufficient surfactant

91
Q

When is extrauterine life possible ?

A

24-25 weeks gestation

92
Q

What drug do you pre-med with in asthma patients?

A

Decadron = 0.2-0.5 mg/kg

93
Q

WIth down syndrome patients, what must you do in your tube calculation?

A

Once you calculate tube size, downsize by 1/2 and use that tube

94
Q

To avoid a sickle cell attack/crisis, what must you do to your patient?

A
    • Keep em warm
    • Keep em hydrated
    • Treat pain aggressively

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