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Advance Principles I, Exam 4 > Peds > Flashcards

Peds Flashcards

0
Q

Look bypasses lungs

A

Blood entering RV & PA bypasses lungs via ductus arteriosis

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1
Q

Pulmonary circulation is passed by

A

Placental blood passes thru Foramen ovale to LA

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2
Q

What happens to PVR & SVR in fetus

A

PVR is high & SVR is low

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3
Q

Birth changes to PBF, PVR, SVR,

A

PBF up, PVR down, PV return up

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4
Q

Umbilical clamping what happens

A

Inc SVR & BP - immediate

Activates Baroreceptors, inc LAP/MAP, dec PAP

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5
Q

What happens to FO at birth

A

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

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6
Q

Why ductus arteriosus constricts

A

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

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7
Q

What can u do to keep DA open

A

Prostaglandin gtts,

avoid high oxygen

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8
Q

PNS vs SNS in neonate

A

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

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9
Q

What are kids under 4 month prone to

A

Bradycardia, causes drop in CO

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10
Q

What are some causes of bradycardia

A

Vagal stimulation
Hypoxia
Anasthetic overdose

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11
Q

Rx for bradycardia in infants

A

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

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12
Q

What is considered the hallmark of IV fluid depletion

A

Hypotension without tachycardia

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13
Q

Adequate urine output for peds

A

1ml/kg/hr

Minimal number of cases will have Foley catheter

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14
Q

Neonates and infants respiratory anatomy

A 
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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15
Q

What does funnel trachea predisposes infants to

A

Post extubation stridor from ETT

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16
Q

True or false

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

A

True

Listen to both sides

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17
Q

Subglottic edema of 1 mm effects

A

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

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

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18
Q

What is Hg level for newborn & 3 months old

A

Newborn 17-19

3 months 9-10

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19
Q

When does physiologic anemia happens?

A

3 months

20
Q

Fetal Hg differences

A
  1. Has a short life span
  2. Higher O2 affinity P50=19, therefore has higher O2 affinity & December release of O2 to tissue
  3. Tissue oxygenation improves with age
21
Q

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

A

Atelectasis & hypoxia

22
Q

Why atelactisis & hypoxemia

A
  1. Dec lung compliance & hypoxemia
  2. These result in dec FRC
  3. High O2 consumption
23
Q

Retinopathy r/t

A

High concentration of O2

- Newborns <90% jeopardizes organ/tissue oxygenation

24
Q

What is the tidal volume

A

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

25
Q

What are type I muscles?

A

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

26
Q

Type II ventilatory muscles

A

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

27
Q 
Diaphragm 
Type 1 in
Premature, 
Newborn 
Infant
A

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

28
Q

Intercostal muscles
Premature
Newborn
Infant

A

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

29
Q

When does diaphragm & intercostal muscle mature

A

Diaphragm 8 months

Intercostal is 2 months

30
Q

Neonates have less type I < type II

Neonates are most susceptible to fatigue with…

A

Airway obstruction
Pneumonia
Secretions

31
Q

Who has less efficient ventilation

A

Neonates have less efficient ventilation & use up lots of energy

32
Q

When do fontanelles close

A

Anterior 18 months to 2 years

Posterior 6 months

33
Q

What is the largest factor in cause of decreased CPP

A

Hypotension

34
Q

What age cerebral blood flow reaches its max

A

5 years old

35
Q

Cerebral blood flow
Preemie
Infant
Adult

A

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

36
Q

What are factors that predispose to intraventricular hemorrhage

A 
Hypoxia
Hypercarbia
Hypernatremia
Fluctuation in arterial/venous pressure & CBF
NaHCO3
37
Q

Preterm cerebral vessels are subject to…

A

HTN, are fragile

38
Q

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

A

Yes, CYP 450, fully functional @1 month

39
Q

Physiologic jaundice

A

Bilirubin levels peak @ 3-5 days of life

40
Q

How is liver during gestation

A

Partially nonfunctional d/t shunted ductal flow

41
Q

Obligate Na losers

A

Neonates continue to excrete Na even in deficit

42
Q

What should fluids always contain in neonates

A

Na,

Low Na can cause seizures

43
Q

GFR is low at birth
1 month
9 months
12 months

A

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

44
Q

What cause GEReflux in infants

A

Incompetent lower esophageal sphincter

High risk for aspiration

45
Q

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

A

Large SA to body surface
Lack of SQ tissue
Large head

46
Q

Steps of thermogenesis

A

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

47
Q

Where is brown fat

A 
Inner scapular space
Around lg brown vessels 
Neck
Behind sternum
Around kidneys/adrenals
48
Q

Effects of hypothermia

A 
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

Advance Principles I, Exam 4 (5 decks)

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