Peds Flashcards
Neonate age?
<30 days
Infant age?
1-12 months
Child age?
1-12 years
Key differences between adult and peds airways:
Tongue, larynx, epiglottis, trachea and neck?
- tongue is larger
- more anterior and cephalad larynx
- long, sometimes floppy epiglottis
- short trachea and neck
What is the narrowest part in peds airway?
Subglottic region at the cricoid cartilage
What is the optimal airway potency for resuscitation?
Slightly extended (sniff position)
Infant lungs versus adult?
Stiff lungs
- lower FRC
- lower closing volume
- lower lung compliance (small alveoli)
Infant chest wall compliance versus adult?
Greater compliance
Infant O2 requirement versus adult?
2x (6ml/kg)
Infant CO2 production versus adult?
2x (ml/kg)
Newborn CO?
4ml/beat
Infants baroreceptor reflex?
Immature
What is the main determinant of CO up to age 2?
HR
Renal function at birth (4)
- Decrease GFR
- Decrease Na excretion
- Decrease concentrating ability
- Retain water
Normal function of renal at what age?
6 months
Adult function of renal at what age?
2 years
GI function (3)
- Prolonged gastric emptying
- Incompetent lower esophageal sphincter
- Increase GERD
Which hepatic phase is: toxins are altered oxidation, reduction, isomerization, and hydrolysis?
Phase 1
Which hepatic phase is: more water soluble and attach to carrier molecules to be transported out?
Phase 2
What is most important is hepatic phase 1?
P-450: endoplasmic reticulum of liver tissues
When does hepatic phase 2 mature?
Not mature for more than 2 weeks
If phase 1 is too rapid compared to phase 2, it can cause what?
Excess free radical activity
Normal hematocrit for full term?
55%
Normal hematocrit for 3 months?
30%
Normal hematocrit for 6 months?
35%
3 options for preop meds?
Versed
Clonidine
Ketamine
Versed oral dosage?
.5mg/kg
Mechanism for clonidine?
Alpha 2 adrenergic agonist
Clonidine intranasal, IM and oral dosage?
Intranasal: 2-4 mcg/kg
IM: 2mcg/kg
Oral: 4-5 mcg/kg
IM ketamine dosage?
3-4mg/kg (up to 10)
Versed or clonidine have faster onset?
Versed
Versed or clonidine level of sedation?
Clonidine better
Increased emergence agitation with versed or clonidine?
Versed
Chest wall rigidity may occur with what in neonates and infants?
Small doses of fent and other synthetic opioids
Chest wall rigidity results in what?
Hypercarbia and hypoxemia
Clear liquids NPO?
2 hrs
Breast milk NPO?
4 hrs
Formula, non human milk NPO?
6 hrs
Premature neonates avg blood volume?
95 ml/kg
Full term neonates avg blood volumes?
85 ml/kg
Infants avg blood volumes?
80 ml/kg
Adult men avg blood volumes?
75 ml/kg
Adult women avg blood volume?
65 ml/kg
Allowable blood loss equation?
ABL=[EBV x (Hi - Hf)]/ Hi
2 peds IV line access?
Saphenous and “love” vein
How long does EMLA cream need to work?
At least 1 hr
Gauge size IV?
22, 24
Drugs needed for peds set up? (3)
Sux, atropine, epi
LMA size for neonate/infant up to 5 kg?
1
LMA size for infants 5-10kg?
1.5
LMA size for infants/children 10-20 kg?
2
LMA size for children 20-30kg?
2.5
LMA size for children/small adults over 30 kg?
3
ETT size for neonate/infants up to 5kg?
3.5
ETT size for infants 5-10kg?
4
ETT size for infants/children 10-20kg?
4.5
ETT size for children 20-30 kg?
5
ETT size for children/small adults over 30 kg?
6
Max cuff volume for neonate/infant up to 5 kg?
4
Max cuff volume for infants 5-10kg?
7
Max cuff volume for infants/children 10-20kg?
10
Max cuff volume for children 20-30kg?
14
Max cuff volume for children/small adults over 30 kg?
20
Max cuff volume for normal and large adolescents/adults?
30
Airway resistance equation?
(8nl)/(pie x r^4)
ETT size for preterm infants?
2
ETT size for 1000g infant?
2.5
ETT size for 1000-2500g?
3
ETT size for neonate-6months?
3-3.5
ETT size for 6months-1 yr?
3.5-4
ETT size for 1-2 years?
4-5
ETT equation for beyond 2 yrs?
(Age in years +16)/4
Optimal size unruffled ETT allows adequate ventilation but leaks about how much of water pressure?
20-25
By what age does anatomy changes and become more adult like? (Triangular vocal cord opening becomes smallest diameter)
8 years
If there is a break in the pressure seal, such as leak around ETT, then ventilation may be inadequate why?
Air takes the path of least resistance back out the mouth, rather than inflating the lungs
Can peds pt potentially aspirate around an uncuffed ETT?
Yes
Pierre-Robin syndrome patients present with (3)
- Cleft palate
2. Small face and glottis
Is Pierre-robin syndrome easy to intubate?
No, very difficult (awake intubation)
-fully awake before extubation
Treacher Collins syndrome presents with (3)
- Downward slanting eyes
- Micrognathia (small lower jaw)
- Malformed or absent ears
3 muscle relaxants able to be used in peds?
- Roc
- Sux
- Vecuronium
Neonat: RR, HR, BP
RR: 40
HR: 140
BP: 65/40
12month: RR, HR, BP?
RR: 30
HR: 120
BP: 95/60
3 yrs: RR, HR, BP?
RR: 25
HR: 100
BP: 100-70
12 yrs: RR, HR, BP?
RR: 20
HR: 80
BP: 110/60
What are the 3 treatments for layrngoaspam?
- Constant positive pressure
- Propofol
- Sux with atropine IV or IM
2 treatments for post-intubation croup?
- Racemic epi
2. Humidified mist
Rating scale for pain used in peds?
Wong-baker faces
What is the FLACC pain scale acrimony stand for?
Face Legs Activity Cry Consolability
Approximate time to 0 O2 sat from inspired concentration of 90% for 10kg child?
4min
What 2 things contribute to more rapid hypoxemia?
- Increased metabolic rate
2. Decreased FRC
Dose of Tylenol for neonates, infants, and children?
PO 10-15 mg/kg
Max Tylenol for neonates?
60 mg/kg/day
Max Tylenol for infants/children?
75 mg/kg/day
Dose for sacral lumbar level block (penile/lower extremity?
.5-.7 ml/kg
Dose for lumbar thoracic level block (lower abdominal)?
1 ml/kg
Dose for upper thoracic level block (upper abdominal)?
1.2 ml/kg
End of spinal cord and dural sac for neonate?
L3 and S4
End of spinal cord and dural sac for 1 yr?
L1 and S2
End of spinal cord and dural sac for adult?
L1 and S2
For spinal dosing with tetracaince, use of Epi wash can increase during up to how long?
120 min
Acute epiglottis is rarely seen now due to what vaccine?
H influenza type B vaccine
Pyloric stenosis is more common in male or female?
Male (4:1)
Pyloric stenosis symptoms are apparent between?
2-6 wk of life
3 physical exam signs for pyloric stenosis?
- Visible gastric peristalsis
- Palpable “olive shaped” mass or the right of the epigastric area
- Dehydration
5 common metabolic abnormalities for pyloric stenosis?
- Hyponatremia
- Hypochloremia
- Hypokalemia
- Primary metabolic alkalosis
- Compensatory respiratory acidosis
3 anesthesia concerns with pyloric stenosis?
- Pulmonary aspiration
- Severe dehydration
- Metabolic acidosis
