Peds Flashcards by Magda S

Look bypasses lungs

Blood entering RV & PA bypasses lungs via ductus arteriosis

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Pulmonary circulation is passed by

Placental blood passes thru Foramen ovale to LA

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What happens to PVR & SVR in fetus

PVR is high & SVR is low

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Birth changes to PBF, PVR, SVR,

PBF up, PVR down, PV return up

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Umbilical clamping what happens

Inc SVR & BP - immediate

Activates Baroreceptors, inc LAP/MAP, dec PAP

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What happens to FO at birth

Inc venous return to LA - FO closes (days to months)

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Why ductus arteriosus constricts

Dec prostaglandins
Inc in blood O2 concentration
DA closes - pulmonary blood flow & O2 uptake inc

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What can u do to keep DA open

Prostaglandin gtts,

avoid high oxygen

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PNS vs SNS in neonate

PNS fully developed, while SNS is not till 4-6 months

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What are kids under 4 month prone to

Bradycardia, causes drop in CO

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What are some causes of bradycardia

Vagal stimulation
Hypoxia
Anasthetic overdose

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Rx for bradycardia in infants

Robinual 10-20 mcq/kg or atropine, same dose

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What is considered the hallmark of IV fluid depletion

Hypotension without tachycardia

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Adequate urine output for peds

1ml/kg/hr

Minimal number of cases will have Foley catheter

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Neonates and infants respiratory anatomy

Lg head & tongue
Long, stiff epiglottis
Funnel shape trachea
Short neck
Nose breathers till 4-6 months
cricoid cartilage is the narrowest point till 5 years old

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What does funnel trachea predisposes infants to

Post extubation stridor from ETT

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True or false

Symmetrical bifurcation of R & L mainstaim bronchus can result in either R or L endobranchial intubation

True

Listen to both sides

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Subglottic edema of 1 mm effects

Peds:
Area reduced by 75%
Airway resistance increased by x16

Adults:
Area reduced by 44%
Airway resistance increased by x3

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What is Hg level for newborn & 3 months old

Newborn 17-19

3 months 9-10

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When does physiologic anemia happens?

3 months

Fetal Hg differences

Has a short life span
Higher O2 affinity P50=19, therefore has higher O2 affinity & December release of O2 to tissue
Tissue oxygenation improves with age

What are neonates and newborns predispose to ( resp system)…

Atelectasis & hypoxia

Why atelactisis & hypoxemia

Dec lung compliance & hypoxemia
These result in dec FRC
High O2 consumption

Retinopathy r/t

High concentration of O2

- Newborns <90% jeopardizes organ/tissue oxygenation

What is the tidal volume

7-10 ml/kg usually PC vent, close to 10

What are type I muscles?

Slow twitch, high oxidative, sustained muscles ( Richard Simmons)

Type II ventilatory muscles

Fast twitch, low oxidative, immediate but short activity (Arnold Schwartzeneger)

``` Diaphragm Type 1 in Premature, Newborn Infant ```

Primary muscle of ventilation Premature : 10% of Type I Newborn : 25% of type I Infant. : 55%- matures at 8 months

Intercostal muscles Premature Newborn Infant

Premature: 20% type I Newborn: 46% Mature at 2 months of age

When does diaphragm & intercostal muscle mature

Diaphragm 8 months | Intercostal is 2 months

Neonates have less type I < type II | Neonates are most susceptible to fatigue with...

Airway obstruction Pneumonia Secretions

Who has less efficient ventilation

Neonates have less efficient ventilation & use up lots of energy

When do fontanelles close

Anterior 18 months to 2 years | Posterior 6 months

What is the largest factor in cause of decreased CPP

Hypotension

What age cerebral blood flow reaches its max

5 years old

Cerebral blood flow Preemie Infant Adult

Preemie: 30-40 ml/100gm/min Infant/child: 65-80 Adult: 50

What are factors that predispose to intraventricular hemorrhage

``` Hypoxia Hypercarbia Hypernatremia Fluctuation in arterial/venous pressure & CBF NaHCO3 ```

Preterm cerebral vessels are subject to...

HTN, are fragile

Are liver enzymes present at birth and what and when fully functional

Yes, CYP 450, fully functional @1 month

Physiologic jaundice

Bilirubin levels peak @ 3-5 days of life

How is liver during gestation

Partially nonfunctional d/t shunted ductal flow

Obligate Na losers

Neonates continue to excrete Na even in deficit

What should fluids always contain in neonates

Na, | Low Na can cause seizures

GFR is low at birth 1 month 9 months 12 months

1 month: 70% mature 9 months : 90% mature 1 year: Almost completely mature

What cause GEReflux in infants

Incompetent lower esophageal sphincter High risk for aspiration

Why infants/neonates/sm kids are at high risk for hypothermia

Large SA to body surface Lack of SQ tissue Large head

Steps of thermogenesis

Cold to hypothalamus ---SNS activation/release of NE---NE stimulates release of lipase from brown fat which splits triglycerides into glycerol & FFA----FFA oxidized ---ATP --- heat

Where is brown fat

``` Inner scapular space Around lg brown vessels Neck Behind sternum Around kidneys/adrenals ```

Effects of hypothermia

``` Inc O2 consumption Metabolic acidosis Inc PVR - intracardiac shunting across PFO or PDA Dec BP - depletion of NE stores Dec BS - depletion of glycogen stores ```