Pediatrics Review* Flashcards
___ closes functionally at birth when LA pressure is > than RA pressure.
- Any change in ___ can cause flow to reverse
- Anatomically closes in ___
PFO
-pressure gradient
3-6 months
____ artery comes off the aorta before the ___.
- Important when placing an A-line
- If we place a right radial a-line measuring ___
- If we place a left radial a-line measuring ___
Right innominate artery
PDA
-pre-ductal oxygen
-post-ductal oxygen
- Babies have a higher ___ hence their increased oxygen consumption
- Limited ___ stores
- ___ dominant
- metabolic demand
- catecholamine
- PSNS
Babies have ____ need really good pre-oxygenation, less safe apnea time.
decreased FRC (25, adult is 40)
- In newborn blood loss >___ may not be tolerated - fetal Hgb
- At ___ the baby will have a physiologic anemia due to fetal Hgb dropping off and adult Hgb increasing
- Hgb considered in context….neonate with Hgb of ___ concerning because majority is fetal Hgb = serious - meanwhile at ___ this Hgb is expected
> 10-15%
2-6 months
10
2 months (10-12)
- HBF ___ in first months of life.
- CYP450 system ___ functional at birth.
- Want to give drugs that don’t rely on hepatic metabolism ??
- Infants have minimal glycogen stores may need maintenance fluid with?
- decreased
- 50%
- atracurium, cisatracurium
- dextrose
- Infants have a high TBW content drugs that are water-soluble (?) will have a larger ___
- Minimal ___ - Less fat for redistribution of drugs = higher availability
Muscle relaxants
volume of distribution
fat stores
General Rule:
- Most PO/IV meds prolonged elimination half time in ___ (decreased dosing intervals)
- Shortened elimination half time in ___
- Normal elimination half time as ?
- infants
- children (2-12 years)
- child approaches adulthood
___ closure after birth is functional, not anatomical.
- Ductus constricts and closes based on levels of ___, ___, ___
- So if the baby gets ___ and ___ this will pop open - this will cause a large % of blood flow to bypass the lungs
- PDA closes anatomically btw ___. ___ will have more delayed closure.
PDA
- O2, CO2, prostaglandins
- acidotic and hypoxic
- 2-6 weeks
- Premies
View of the pediatric airway is usually almost always better with a ?
straight blade
Fluid Choices:
- For children less than 2 years old use a ___ filled with ___ at a time
- If greater than 2 years old use ___ with only ___ up at a time
- buretrol filled with 25-100 mL
- mini gtt with only 500 mL bag
Pediatric Differences:
- Babies and children adjust CO and BP by ___. They have poor ___.
- Higher ___ demand.
- ___ thus have limited ability to handle fluid overload or increased SV.
- HR
- contractile strength
- metabolic
- Noncompliant LV
-In regards to respiratory peds patients known to have ~ small \_\_\_/highly \_\_\_ -Depress ventilation?? -Decreased \_\_\_ muscle fibers -Smaller number of \_\_\_
- small diameter/highly compliant airways
- hypoxia and hypercapnia
- Type 1
- alveoli
Babies have decreased ___ need really good pre-oxygenation due to less safe apnea time
- Ideal position for intubation of the very young child/neonate?
- If suspect traumatic intubation give?
FRC
(babies = 25, adults = 40)
-Neutral or slightly flexed
-Decadron or racemic epinephrine
Neonates ~ ECF = ___ of body weight, TBW = ___
@ 2 years ~ ECF = ___ of body weight
*Neonates are at increased risk for ___ = always concerned about ___
-Normal kidney function at ___
40%, 78% 20% *evaporative losses dehydration -6 months
Hepatic - impaired conjugation - jaundice
*___ reaction, ___ reaction (example: morphine relies on this for metabolism) less mature in babies
Phase 2 reaction, conjugation reaction
- Opioids will decrease the ___ requirement
- Decrease HR and cause respiratory depression?
- Prefer to give?
- MAC
- Opioids
- Fentanyl
Succinylcholine dose in pediatric population - IV? IM?
Always administered with?
*Appropriate time to administer succ to a child less than 5 years old??
1-2 mg/kg IV
4-5 mg/kg
Atropine
*laryngospasm and RSI (can also use high dose rocuronium)
Reversals for peds??
- Equipment need at least __ suction catheters, __ blade is best, and ___ (used during induction to listen to heart tones)
- Nasal or oral airway?
Neostigmine 0.02-0.05 mg/kg with Glycopyrrolate 0.02 mg/kg
Edrophonium 0.3-1 mg/kg with Atropine 0.02 mg/kg
-2
-Miller
-Precordial stethoscope
-Oral preferred
Cuffed ETT worried about tracheal mucosa pressure from ___ of ETT.
- Need to do a leak test (close APL and provide PP ventilation to hear)
- arbitrary value of leak at ___
- if patient has a leak at ___ need larger uncuffed ETT or inflate cuff
- if patient does not have a leak at ___ need smaller uncuffed ETT or deflate the cuff
external diameter
- less than 25 cmH2O (20-30)
- less than 20 cmH2O
- greater than 40 cmH2O
- For maintenance requirement? (not used for fluid replacement) (used more in ??)
- For deficits and third space losses?
-D5 in 0.45%
neonates and infants
-LR
- During mask ventilation keep your fingers off ___
- Always keep equipment one size larger and one size smaller than anticipated
- After tracheal intubation you must always check for?
- Need to consider loose teeth in?
- soft tissue
- a leak
- school age children
Preop physical exam:
- ask for birth history for kids ___ (were they premature, etc.)
- ___ = want details about the birth and mother’s health status (diabetes, preeclampsia, HTN)
- less than or equal to 5 years old
- neonates
Premedicate with ___ or ___
*Premedication
-___
PO 0.25-1 mg/kg, max?, nasal/SL 0.2 mg/kg, IM 0.1-0.15 mg/kg max?
-___ good for uncooperative kids PR/IM = 5-10 mg/kg
Benzos or opioids -Midazolam 20 mg 7.5 mg -Ketamine
