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AA1 > peds 1 > Flashcards

peds 1 Flashcards

1
Q

pre-term

A

prior to 37 weeks gestational age

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2
Q

neonate

A

1-28 days of life

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3
Q

infant

A

28 days - 1 year

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4
Q

child

A

> 1 year

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5
Q

most significant part of transition occurs within the first

A

24-72 hours after birth with adaptive changes in all organ systems

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6
Q

4 adaptive changes

A

establish FRC,
Convert circulation,
recover from birth asphyxia,
maintain core temperature

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7
Q

Fetal hgb totals

A

70-90%

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8
Q

Fetal hgb shifts oxyhmoglobin dissociation curve to

A

left(increased o2 loading in the lungs/placenta, decreased o2 unloading at tissues)

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9
Q

hgb full term neonate

A

18-20g/dl (o2 unloading insufficient after birth)

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10
Q

fetal lung dev.-primitive lung buds develop from foregut

A

4 weeks

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11
Q

fetal lung dev. - branching of bronchial tree complete to 28 divisions, no further formation of cartilaginous airways

A

16 weeks

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12
Q

fetal lung dev. - primitive alveoli (saccules) and type II cells present; surfactant detectable; survival possible with artificial ventilation

A

24 weeks

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13
Q

fetal lung dev. - capillary network surrounds saccules; unsupported survival

A

28-30 weeks

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14
Q

fetal lung dev. - true alveoli present, roughly 20 million at birth

A

35-40weeks

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15
Q

fetal lung dev. - PaO2 rises as R to L mechanical shunts close

A

birth-3months

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16
Q

fetal lung dev. - rapid increase in alveoli 350million at age 6

A

to 6 years

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17
Q

“guppy breathing in utero” present from ___ weeks gestation, ____% of the time at a rate of __ breaths/min

A

30 weeks, 30%, 60 breaths/min

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18
Q

traditional view of adaption of breathing vs fetal lamb studies

A

traditional(hypoxemia, hypercarbia, and acidosis of birth asphyxia stimulates chemoreceptors that produce gasping followed by rhythmic breathing. lamb(studies shown total denervation of carotid, aortic, and peripheral chemoreceptors does not alter fetal breathing or initiation)

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19
Q

What changes are responsible for the decrease in PVR

A

Increase in PO2,
Decrease in PCO2,
change in pH

20
Q

Decrease in PVR, _____ pulmonary blood flow

A

increases

21
Q

Current adaption of breathing view

A

rhythmic breathing occurs with clamping of the umbilical cord and increasing O2 tensions from air breathing

22
Q

What is the primary event of the respiratory system transition?

A

Initiation of Ventilation

changes alveoli from a fluid filled to and air filled state

23
Q

Negative pressure infant must generated to inflate the lungs

A

-70cm H2O

24
Q

neonate FRC approx

A

25-30mL/kg

25
Q

why are neonate and infant lungs prone to collapse?

A

weak elastic recoil,
weak intercostal muscles,
intra-thoracic airways collapse during exhalation

26
Q

_____ closing volume encroaches upon FRC - _____ airway closure begins at volumes at or ______ FRC leading to lung collapse and V/Q mismatch

A

High,
small,
above

27
Q

Why don’t infants have lung collapse all of the time? Infants terminate the expiratory phase of breathing before reaching their true FRC which results in intrinsic PEEP and a higher FRC. When anesthetized, however, this protective mechanism is abolished. The opposing tonic state of the intercostal muscles is overridden and atelectasis occurs. The moral of this story

A

PEEP of 5cm H2O can help maintain FRC/lung inflation in the neonate during anesthesia

28
Q

respiratory control is poorly developed in neonates. The system is normal by ___ weeks of age, but likely remains ______ for some time, especially in preterm babies

A

3-4 weeks,

immature

29
Q

how do newborns respond to hyper-carbia

A

increasing ventilation, but the slope of the response curve is decreased

30
Q

what depresses neonate’s response to CO2?

A

hypoxia

31
Q

biphasic response to hypoxia

A

initial hyperpnea followed by depression of respiration in about 2min

32
Q

***Initial hyperpneic response is abolished by ______ and low levels of _________ gases

A

hypothermia,

anesthetic

33
Q

by 3 weeks of age, hypoxia produces sustained

A

hyperventilation

34
Q

_____ is a common response and a real danger, especially in preterm infants

A

apnea

35
Q

respiratory pauses exceeding ___ sec or those accompanied by bradycardia or cyanosis

A

Apnea of infancy

20 seconds

36
Q

Hypoxia causes PROFOUND ______ in babies

A

bradycardia

37
Q

Increased work of breathing=

A

FATIGUE

38
Q

Contributing factors for apnea of infancy

A

increased O2 consumption 6mL/kg,
decreased FRC,
increased closing volume

39
Q

where does gas exchange in the fetus

A

the placenta

40
Q

in the fetus lungs require what percentage of CO

A

5-10%, only nutrient flow

41
Q

fetal intracardiac and extracardiac shunts exist to

A

minimize blood flow to the lungs while maximizing flow/O2 delivery to organ systems

42
Q

Name of fetal shunts

A

ductus venosus,
foramen ovale,
ductus arteriosus

43
Q

_______ blood travels the _______ aorta to the _______ arteries to the placenta(very low resistance to flow),
______ blood returns via the umbilical vein (PO2 35mmHg), ductus _____ diverts approx. ___% of blood away from the liver into the IVC then to the _____

A 
Deoxygenated,
descending,
umbilical,
oxygenated,
venosus,
50,
RA
44
Q

_____ blood directed across the foramen ovale, fed to LV, ejected to aorta feeding coronary and cerebral circulations

A

O2 rich

45
Q

SVC and hepatic venous flow delivered to the ____

A

RV

46
Q

fetal circulation pulmonary vascular resistance is

A

HIGH!!!

47
Q

____ output is delivered across the ductus arteriosus which connects the ___ to the ______ ________

A

RV,
PA,
descending aorta

AA1 (7 decks)

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